Percutaneous Mechanical Circulatory Support in PosteMyocardial Infarction Cardiogenic Shock: A Systematic Review and Meta-analysis

Background: Cardiogenic shock (CS) complicates 5%-10% of acute myocardial infarction (AMI) and is the leading cause of early mortality. It remains unclear whether percutaneous mechanical support (pMCS) devices improve post-AMI CS outcome. Methods: A systematic review of original studies comparing the effect of pMCS on AMI-CS mortality was conducted with the use of Medline, Embase, Google Scholar, and the Cochrane Library databases. Results: Of 8672 records, 50 were retained for quantitative analysis. Four additional references were added from other sources. Four references reported a significant mortality reduction with intra-aortic balloon pump (IABP) in patients with failed primary percutaneous coronary intervention (pPCI) or managed with thrombolysis. Metaanalyses showed no advantage of Impella over conventional therapy (pooled OR 0.55, 95% CI 0.20-1.46; I-2 = 0.85) and increased mortality compared with IABP (pooled OR 1.32; 95% CI 1.08-1.62; I-2 = 0.85).No study reported a mortality advantage for extracorporeal membrane oxygenation (ECMO) over conventional therapy, IABP, or Impella support. Early mortality might be improved with the addition of IABP or Impella to ECMO. Bleeding Academic Research Consortium >= 3 bleeding was increased with every pMCS strategy. Conclusions: The current evidence is of poor to moderate quality, with only 1 in 5 included articles reporting randomised data and several reporting unadjusted outcomes. Yet, there is some evidence to favour IABP use in the setting of thrombolysis or with failed pPCI, and adding IABP or Impella should be considered for patients requiring ECMO.

Automated summary

There is limited evidence on the effectiveness of percutaneous mechanical support devices in improving outcomes for patients with acute myocardial infarction complicated by cardiogenic shock. However, the use of intra-aortic balloon pump may reduce mortality in patients undergoing thrombolysis or those with failed primary percutaneous coronary intervention. Adding intra-aortic balloon pump or Impella support should be considered for patients requiring extracorporeal membrane oxygenation. Overall, the quality of evidence is poor to moderate.