期刊
EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE
卷 10, 期 9, 页码 1009-1015出版社
OXFORD UNIV PRESS
DOI: 10.1093/ehjacc/zuab060
关键词
Cardiogenic shock; Mechanical circulatory support; Acute myocardial infarction; Randomized controlled trial; Intra-aortic balloon pump
The study compared long-term outcomes and functional status of patients with cardiogenic shock treated with percutaneous mechanical circulatory support (pMCS) and intra-aortic balloon pump (IABP). There was no significant difference in 5-year mortality between the two treatment groups, but the occurrence of major adverse cardiac and cerebrovascular events (MACCE) differed. Most survivors had good heart function and no residual angina.
Aims To assess differences in tong-term outcome and functional status of patients with cardiogenic shock (CS) treated by percutaneous mechanical circulatory support (pMCS) and intra-aortic balloon pump (IABP). Methods and results Long-term follow-up of the multicentre, randomized IMPRESS in Severe Shock trial (NTR3450) was performed 5-year after initial randomization. Between 2012 and 2015, a total of 48 patients with severe CS from acute myocar-dial infarction (AMI) with ST-segment elevation undergoing immediate revascularization were randomized to pMCS by Impella CP (n = 24) or IABP (n = 24). For the 5-year assessment, alt-cause mortality, functional status, and occurrence of major adverse cardiac and cerebrovascular event (MACCE) were assessed. MACCE consisted of death, myocardial re-infarction, repeat percutaneous coronary intervention, coronary artery bypass grafting, and stroke. Five-year mortality was 50% (n = 12/24) in pMCS patients and 63% (n = 15/24) in IABP patients (relative risk 0.87, 95% confidence interval 0.47-1.59, P = 0.65). MACCE occurred in 12/24 (50%) of the pMCS patients vs. 19/24 (79%) of the IABP patients (P = 0.07). All survivors except for one were in New York Heart Association Class I/II [pMCS n = 10 (91%) and IABP n = 7 (100%), P = 1.00] and none of the patients had residual angina. There were no differences in Left ventricular ejection fraction between the groups (pMCS 52 +/- 11% vs. IABP 48 +/- 10%, P = 0.53). Conclusions In this explorative randomized trial of patients with severe CS after AMI, there was no difference in long-term 5-year mortality between pMCS and IABP-treated patients, supporting previously published short-term data and in accordance with other long-term CS trials. [GRAPHICS] .
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