Prognostic Impact of the Difference of Mechanical Circulatory Support in Patients With Acute Coronary Syndrome Complicated by Cardiogenic Shock　― A Systematic Review and Meta-Analysis ―

抄録

Background: The optimal device for mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS) remains unknown. Therefore, in this study we aimed to analyze which MCS (intra-aortic balloon pumping (IABP) or IMPELLA) is associated with better outcomes in patients with AMI-related CS.

Methods and Results: This systematic review and meta-analysis used a random-effects model to account for potential heterogeneity. Risk ratios (RRs) and 95% confidence intervals (CIs) were used for the dichotomous outcomes. The PubMed, Web of Science, and CENTRAL databases were searched up to April 30, 2023. The risk of bias was evaluated using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2) tool, and the certainty of evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Two randomized controlled trials were included in the meta-analysis. For the primary outcome of 30-day survival, IMPELLA probably improves the outcome by a small amount compared with IABP (RR0.94 [95% CI 0.5–1.53], 29 fewer per 1,000 [95% CI from 204 fewer to 258 more], low certainty of evidence).

Conclusions: We could not show a survival benefit of IMPELLA compared with IABP in patients with AMI complicated by CS. Further investigation is required to resolve this issue.