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Impella in cardiogenic shock following acute myocardial infarction: a systematic review and meta-analysis

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Summary

Background and objective

Cardiogenic shock (CS) conveys a high mortality risk. A cardiac assist device may serve as bridge to patient recovery. We aimed to provide a pooled estimate on mortality and complications from studies evaluating the use of the left ventricular assist device Impella in CS following acute myocardial infarction. In addition, we evaluated whether mortality risk differed with device placement before or after percutaneous coronary intervention (PCI).

Methods

We searched Medline, Embase and Web of Science from 2005 until July 2019 for observational studies or clinical trials on this specific patient group. Studies were required to report on 30-day all-cause mortality and device-related complications. We calculated pooled proportions with 95% confidence intervals (CI) using random effects models and the inverse variance method.

Results

Overall, 671 patients from 11 studies (2 randomized and 9 observational) were included. Pooled proportions showed a 30-day mortality of 54.6% (95% CI 47.3–61.8; P = 0.22; I2 = 65.8%). Among complications, major bleeding was found in 19.9% (95% CI 14.2–27.3; P < 0.05; I2 = 69.1%), hemolysis in 10.5% (95% CI 7.2–15.0; P < 0.05; I2 = 52.1%), limb ischemia in 5.0% (95% CI 2.6–9.5; P < 0.05; I2 = 48.3%) and stroke in 3.8% of patients (95% CI 2.4–5.9; P < 0.05; I2 = 0%). Sensitivity analysis demonstrated a statistically significant risk reduction in 30-day mortality when Impella was implanted prior to PCI as compared to after PCI, risk ratio (RR): 0.71, CI 0.58–0.86, P = 0.001, I2 = 0%.

Conclusion

Pooled estimates of Impella use in myocardial infarction with CS revealed a high 30-day mortality; however, as compared to post-PCI, Impella initiation prior to PCI was associated with a survival benefit.

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Funding

This work was supported by an unrestricted grant from the Association for the Promotion of Research in Arteriosclerosis, Thrombosis and Vascular Biology (ATVB) and by the Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria. The study funders had no role in the design or conduct of the study.

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Authors and Affiliations

  1. 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria

    Kris G. Vargas MD, MHSc, MSc, Bernhard Jäger MD, Christoph C. Kaufmann MD, Alexander Geppert MD &  Kurt Huber MD

  2. Medical University of Vienna, Vienna, Austria

    Kris G. Vargas MD, MHSc, MSc

  3. Department of Cardiology and Angiology, HerzZentrum Saar, Völklingen, Germany

    Kris G. Vargas MD, MHSc, MSc, Andrea Biagioli MD, Stephan Watremez MD, Fernando Gatto MD & Cem Özbek MD

  4. Department of Cardiology, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany

    Amjad Razouk MD

  5. Medical School, Sigmund Freud Private University, Vienna, Austria

    Bernhard Jäger MD &  Kurt Huber MD

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  1. Kris G. Vargas MD, MHSc, MSc
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Correspondence to Kris G. Vargas MD, MHSc, MSc.

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K.G. Vargas, B. Jäger, C.C. Kaufmann, A. Biagioli, S. Watremez, F. Gatto, C. Özbek, A. Razouk, A. Geppert, and K. Huber declare that they have no competing interests.

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Vargas, K.G., Jäger, B., Kaufmann, C.C. et al. Impella in cardiogenic shock following acute myocardial infarction: a systematic review and meta-analysis. Wien Klin Wochenschr 132, 716–725 (2020). https://doi.org/10.1007/s00508-020-01712-y

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