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Lin W, Yip ACL, Cherian R, Chan SP, Evangelista LKM, Sari NY, Ling HS, Lim YC, Wong RCC, Tung BWL, Tan LL, Low AF, Ambhore AA, Lim SL. Predictors of Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock despite Intra-Aortic Balloon Pump: Opportunities for Advanced Mechanical Circulatory Support in Asia. Life (Basel) 2024; 14:577. [PMID: 38792598 PMCID: PMC11122050 DOI: 10.3390/life14050577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/21/2024] [Accepted: 04/29/2024] [Indexed: 05/26/2024] Open
Abstract
Introduction: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) mortality remains high despite revascularization and the use of the intra-aortic balloon pump (IABP). Advanced mechanical circulatory support (MCS) devices, such as catheter-based ventricular assist devices (cVAD), may impact mortality. We aim to identify predictors of mortality in AMI-CS implanted with IABP and the proportion eligible for advanced MCS in an Asian population. Methods: We retrospectively analyzed a cohort of Society for Cardiovascular Angiography and Intervention (SCAI) stage C and above AMI-CS patients with IABP implanted from 2017-2019. We excluded patients who had IABP implanted for indications other than AMI-CS. Primary outcome was 30-day mortality. Binary logistic regression was used to calculate adjusted odds ratios (aOR) for patient characteristics. Results: Over the 3-year period, 242 patients (mean age 64.1 ± 12.4 years, 88% males) with AMI-CS had IABP implanted. 30-day mortality was 55%. On univariate analysis, cardiac arrest (p < 0.001), inotrope/vasopressor use prior to IABP (p = 0.004) was more common in non-survivors. Non-survivors were less likely to be smokers (p = 0.001), had lower ejection fraction, higher creatinine/ lactate and lower pH (all p < 0.001). On multi-variate analysis, predictors of mortality were cardiac arrest prior to IABP (aOR 4.00, CI 2.28-7.03), inotrope/vasopressor prior to IABP (aOR 2.41, CI 1.18-4.96), lower arterial pH (aOR 0.02, CI 0.00-0.31), higher lactate (aOR 2.42, CI 1.00-1.19), and lower hemoglobin (aOR 0.83, CI 0.71-0.98). Using institutional MCS criteria, 106 patients (44%) would have qualified for advanced MCS. Conclusions: Early mortality in AMI-CS remains high despite IABP. Many patients would have qualified for higher degrees of MCS.
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Affiliation(s)
- Weiqin Lin
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Alfred Chung Lum Yip
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
| | - Robin Cherian
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Siew Pang Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
- Cardiovascular Research Institute, National University Heart Centre, Singapore 119074, Singapore
| | - Lauren Kay Mance Evangelista
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
- De La Salle Medical and Health Sciences Institute, Dasmarinas 4114, Philippines
- Department of Cardiology, University of the Philippines—Philippine General Hospital, Manilla 1000, Philippines
| | - Novi Yanti Sari
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
- Dr Mohammad Hoesin General Hospital Palembang, South Sumatra, Kota Palembang 30126, Indonesia
| | - Hwei Sung Ling
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
- Department of Medicine, Faculty of Medicine and Health Science, Universiti Malaysia Sarawak, Kota Samarahan 94300, Malaysia
- Department of Cardiology, Sarawak Heart Centre, Kota Samarahan 94300, Malaysia
| | - Yoke Ching Lim
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Raymond Ching Chiew Wong
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Benjamin Wei Liang Tung
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
| | - Li-Ling Tan
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Adrian F. Low
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Anand Adinath Ambhore
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore 119074, Singapore (R.C.); (L.K.M.E.); (H.S.L.); (A.F.L.)
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
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Zhang Q, Han Y, Sun S, Zhang C, Liu H, Wang B, Wei S. Mortality in cardiogenic shock patients receiving mechanical circulatory support: a network meta-analysis. BMC Cardiovasc Disord 2022; 22:48. [PMID: 35152887 PMCID: PMC8842943 DOI: 10.1186/s12872-022-02493-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/04/2022] [Indexed: 11/10/2022] Open
Abstract
Objective Mechanical circulatory support (MCS) devices are widely used for cardiogenic shock (CS). This network meta-analysis aims to evaluate which MCS strategy offers advantages. Methods A systemic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials was performed. Studies included double-blind, randomized controlled, and observational trials, with 30-day follow-ups. Paired independent researchers conducted the screening, data extraction, quality assessment, and consistency and heterogeneity assessment. Results We included 39 studies (1 report). No significant difference in 30-day mortality was noted between venoarterial extracorporeal membrane oxygenation (VA-ECMO) and VA-ECMO plus Impella, Impella, and medical therapy. According to the surface under the cumulative ranking curve, the optimal ranking of the interventions was surgical venting plus VA-ECMO, medical therapy, VA-ECMO plus Impella, intra-aortic balloon pump (IABP), Impella, Tandem Heart, VA-ECMO, and Impella plus IABP. Regarding in-hospital mortality and 30-day mortality, the forest plot showed low heterogeneity. The results of the node-splitting approach showed that direct and indirect comparisons had a relatively high consistency. Conclusions IABP more effectively reduce the incidence of 30-day mortality compared with VA-ECMO and Impella for the treatment of CS. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02493-0.
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Kuroki N, Nagao K, Otsuka T, Kuwabara M, Nakata J, Takayama T, Hosokawa Y, Ashida T, Suzuki K, Yamamoto T, Takayama M. Combined use of venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pump after cardiac arrest. Resuscitation 2021; 167:345-354. [PMID: 34314778 DOI: 10.1016/j.resuscitation.2021.07.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/02/2021] [Accepted: 07/15/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVES We investigated whether intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) was associated with favourable neurological outcomes for patients after the return of spontaneous circulation (ROSC). Moreover, we evaluated the aetiology of cardiac arrest on the effectiveness of this therapy in a sub-study. BACKGROUND There is insufficient research on the optimal combination of machines for patients after ROSC is not established. METHODS This is a large-scale, multicentre, 30-day cohort study. Among 80,716 patients who delivered to the emergency room, 935 patients treated with VA-ECMO after ROSC were included using the data from the Tokyo Cardiovascular Care Unit Network Registry between 2010 and 2017. The study patients were stratified according to the use of IABP [the ECMO + IABP group (n = 762) vs. the ECMO-alone group (n = 173)]. We also evaluated the cause of cardiac arrest [acute coronary syndrome (ACS) and non-ACS] in the sub-study. To adjust the patients' backgrounds, we used the propensity score matching for additional analyses. The endpoint was 30-day favourable neurological outcome. RESULTS The ECMO + IABP group showed significantly better neurological outcomes than the ECMO-alone group (crude; 35% vs. 25%; log-lank P < 0.001). In the ACS subgroup, the ECMO + IABP group showed significantly better neurological outcome (crude; 34% vs. 18%; log-lank P < 0.001), but not in the non-ACS subgroup (crude; 38% vs. 32%; log-lank P = 0.11). These results are similar after adjustments to their backgrounds using propensity matching. CONCLUSIONS Compared to VA-ECMO alone, the combined use of VA-ECMO and IABP is associated with better neurological outcomes after ROSC, especially in complicated ACS.
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Affiliation(s)
- Norihiro Kuroki
- Tokyo CCU Network, Scientific Committee, Tokyo, Japan; Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan.
| | - Ken Nagao
- Tokyo CCU Network, Scientific Committee, Tokyo, Japan
| | - Toshiaki Otsuka
- Tokyo CCU Network, Scientific Committee, Tokyo, Japan; Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan
| | | | - Jun Nakata
- Tokyo CCU Network, Scientific Committee, Tokyo, Japan
| | | | | | | | - Kou Suzuki
- Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Chang K, Ahn Y, Lim S, Yang JH, Lee KY, Choo EH, Kim HK, Nam CW, Kim W, Hwang JY, Rha SW, Kim HS, Cho MC, Jang Y, Jeong MH. 2021 Korean Society of Myocardial Infarction Expert Consensus Document on Revascularization for Acute Myocardial Infarction. Korean Circ J 2021; 51:289-307. [PMID: 33821579 PMCID: PMC8022023 DOI: 10.4070/kcj.2021.0043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/03/2021] [Indexed: 01/30/2023] Open
Abstract
Acute myocardial infarction (AMI) is a fatal manifestation of ischemic heart disease and remains a major public health concern worldwide despite advances in its diagnosis and management. The characteristics of patients with AMI, as well as its disease patterns, have gradually changed over time in Korea, and the outcomes of revascularization have improved dramatically. Several characteristics associated with the revascularization of Korean patients differ from those of patients in other countries. The sophisticated state of AMI revascularization in Korea has led to the need for a Korean expert consensus. The Task Force on Expert Consensus Document of the Korean Society of Myocardial Infarction has comprehensively reviewed the outcomes of large clinical trials and current practical guidelines, as well as studies on Korean patients with AMI. Based on these comprehensive reviews, the members of the task force summarize the major guidelines and recent publications, and propose an expert consensus for revascularization in patients with AMI.
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Affiliation(s)
- Kiyuk Chang
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sungmin Lim
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kwan Yong Lee
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Ho Choo
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
| | - Chang Wook Nam
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Weon Kim
- Division of Cardiovascular, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea
| | - Jin Yong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Seung Woon Rha
- Divison of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Hyo Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Myeong Chan Cho
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Yangsoo Jang
- Divison of Cardiology, Department of Internal Medicine, Severance Hospital, Seoul, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea.
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Postcardiac arrest ischemia/reperfusion pathophysiology and functional outcome: Can intra-aortic balloon counterpulsation confer any overall or patient-specific benefit? Resuscitation 2019; 143:214-216. [PMID: 31404635 DOI: 10.1016/j.resuscitation.2019.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 01/13/2023]
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Kishimori T, Matsuyama T, Yamada T, Hayakawa K, Yoshiya K, Irisawa T, Noguchi K, Nishimura T, Uejima T, Yagi Y, Kiguchi T, Kishimoto M, Matsuura M, Hayashi Y, Sogabe T, Morooka T, Sado J, Shida H, Kiyohara K, Shimazu T, Kawamura T, Iwami T, Kitamura T. Intra-aortic balloon pump and survival with favorable neurological outcome after out-of-hospital cardiac arrest: A multicenter, prospective propensity score-matched study. Resuscitation 2019; 143:165-172. [PMID: 31302105 DOI: 10.1016/j.resuscitation.2019.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/10/2019] [Accepted: 07/01/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study aimed to evaluate whether intra-aortic balloon pump (IABP) use in nontraumatic out-of-hospital cardiac arrest (OHCA) patients who achieved return of spontaneous circulation (ROSC) is associated with favorable neurological outcome after OHCA. BACKGROUND The association between the IABP use in OHCA patients and favorable neurological outcome has not been extensively evaluated. METHODS The Comprehensive Registry of Intensive Cares for OHCA Survival (CRITICAL) study, a multicenter, prospective observational registry in Osaka, Japan, included consecutive nontraumatic OHCA patients aged ≥18 years who achieved ROSC from July 2012 to December 2016. The primary outcome was 1-month survival with favorable neurological outcome. Logistic regression analysis was used to evaluate the association between the IABP use or non-IABP use and favorable neurological outcome using one-to-one propensity score (PS) matching analysis. RESULTS Among the 2894 eligible patients, 10.4% used IABP, and 89.6% did not use IABP. In all patients, the proportion of 1-month survival with favorable neurological outcome was higher in the IABP use group than in the non-IABP use group (30.7% [92/300] vs. 13.2% [342/2594]). However, in PS-matched patients, the proportions of 1-month survival with favorable neurological outcome were almost consistent, and there were no significant differences between the IABP use group and the non-IABP use group (37.3% [59/158] vs. 41.1% [65/158]; adjusted odds ratio, 0.97; 95% confidence interval, 0.48-1.96). CONCLUSIONS In this population, the current PS matching analysis did not reveal any association between the IABP use and 1-month survival with favorable neurological outcome among adult patients with ROSC after OHCA.
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Affiliation(s)
- Takefumi Kishimori
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoki Yamada
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan; Emergency and Critical Care Medical Center, Osaka Police Hospital, Osaka, Japan
| | - Koichi Hayakawa
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan
| | - Kazuhisa Yoshiya
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuo Noguchi
- Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
| | - Tetsuro Nishimura
- Department of Critical Care Medicine, Osaka City University, Osaka, Japan
| | - Toshifumi Uejima
- Department of Emergency and Critical Care Medicine, Kinki University School of Medicine, Osaka-Sayama, Japan
| | - Yoshiki Yagi
- Osaka Mishima Emergency Critical Care Center, Takatsuki, Japan
| | - Takeyuki Kiguchi
- Kyoto University Health Services, Kyoto, Japan; Critical Care and Trauma Center, Osaka General Medical Center, Osaka, Japan
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, Higashi-Osaka, Japan
| | | | - Yasuyuki Hayashi
- Senri Critical Care Medical Center, Saiseikai Senri Hospital, Suita, Japan
| | - Taku Sogabe
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takaya Morooka
- Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Junya Sado
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Haruka Shida
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, Tokyo, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Taku Iwami
- Kyoto University Health Services, Kyoto, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan.
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Pressman A, Sawyer KN, Devlin W, Swor R. Association between percutaneous hemodynamic support device and survival from cardiac arrest in the state of Michigan. Am J Emerg Med 2018; 36:834-837. [DOI: 10.1016/j.ajem.2017.10.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 10/12/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022] Open
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Romeo F, Acconcia MC, Sergi D, Romeo A, Francioni S, Chiarotti F, Caretta Q. Percutaneous assist devices in acute myocardial infarction with cardiogenic shock: Review, meta-analysis. World J Cardiol 2016; 8:98-111. [PMID: 26839661 PMCID: PMC4728111 DOI: 10.4330/wjc.v8.i1.98] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/19/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the impact of percutaneous cardiac support in cardiogenic shock (CS) complicating acute myocardial infarction (AMI), treated with percutaneous coronary intervention.
METHODS: We selected all of the studies published from January 1st, 1997 to May 15st, 2015 that compared the following percutaneous mechanical support in patients with CS due to AMI undergoing myocardial revascularization: (1) intra-aortic balloon pump (IABP) vs Medical therapy; (2) percutaneous left ventricular assist devices (PLVADs) vs IABP; (3) complete extracorporeal life support with extracorporeal membrane oxygenation (ECMO) plus IABP vs IABP alone; and (4) ECMO plus IABP vs ECMO alone, in patients with AMI and CS undergoing myocardial revascularization. We evaluated the impact of the support devices on primary and secondary endpoints. Primary endpoint was the inhospital mortality due to any cause during the same hospital stay and secondary endpoint late mortality at 6-12 mo of follow-up.
RESULTS: One thousand two hundred and seventy-two studies met the initial screening criteria. After detailed review, only 30 were selected. There were 6 eligible randomized controlled trials and 24 eligible observational studies totaling 15799 patients. We found that the inhospital mortality was: (1) significantly higher with IABP support vs medical therapy (RR = +15%, P = 0.0002); (2) was higher, although not significantly, with PLVADs compared to IABP (RR = +14%, P = 0.21); and (3) significantly lower in patients treated with ECMO plus IABP vs IABP (RR = -44%, P = 0.0008) or ECMO (RR = -20%, P = 0.006) alone. In addition, Trial Sequential Analysis showed that in the comparison of IABP vs medical therapy, the sample size was adequate to demonstrate a significant increase in risk due to IABP.
CONCLUSION: Inhospital mortality was significantly higher with IABP vs medical therapy. PLVADs did not reduce early mortality. ECMO plus IABP significantly reduced inhospital mortality compared to IABP.
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