Meta-analysis of early initiation of impella in acute myocardial infarction and cardiogenic shock
Flaherty M, Khan A, O'Neill W. Meta-analysis of early initiation of impella in acute myocardial infarction and cardiogenic shock. J Am Coll Cardiol. 2017;70(18):B244.
J Am Coll Cardiol
BACKGROUND Acute myocardial infarction (AMI) complicated by cardiogenic shock (AMICS) has a reportedly high mortality despite early revascularization. The percutaneous micro-axial flow mechanical circulatory support (pMCS) device Impella provides significantly better hemodynamic support, however, no consensus exists regarding a survival advantage with Impella. We performed a meta-analysis to estimate the difference in clinical outcomes wiith 'early' Impella compared with 'late' Impellasupport. METHODS Electronic databases were searched for relevant studies through March 2017. 'Early' implantation was defined as Impella placement either prior to percutaneous coronary intervention (PCI) or early on during angiography and 'late' implantation was placement ofImpella post-revascularization. The outcomes of interest were either in-hospital or 30-day mortality. We pooled the adjusted risk ratio by a generic inverse-variance method using a fixed effect model as there was no between-study heterogeneity found. RESULTS Our search strategy yielded three relevant studies. The meta-analysis suggests a survival benefit with early Impella implantation (RR, 0.52 95% CI, 0.31 - 0.88, I2 = 0%, p = 0.01). There was no between study heterogeneity CONCLUSION Our meta-analysissuggests that early Impella in AMICS decreased in-hospital or 30-day mortality compared with late Impella. However, prospective studies are needed to confirm our findings and change practice patterns.