Meta-Analysis and Trial Sequential Analysis Comparing Percutaneous Ventricular Assist Devices Versus Intra-Aortic Balloon Pump During High-Risk Percutaneous Coronary Intervention or Cardiogenic Shock
Section snippets
Methods
Using the PubMed U.S National Library of Medicine, Cochrane Central Register of Controlled Trials, and EMBASE, we searched for RCTs and nonrandomized studies that compared pVAD versus IABP in patients who underwent high-risk PCI or in patients with CS, from inception to January 2018.
We selected RCTs and nonrandomized studies that compared the use of IABP with or to pVAD (Impella, TandemHeart or both) in patients older than 18years, who underwent high-risk PCI in patients with multivessel
Results
A total of 214 abstracts were screened, 186 studies were excluded, and 27 studies were assessed for full-text eligibility. There were 5 RCTs5,19, 20, 21, 22, 23 and 1 nonrandomized study24 included (Figure 1) which compared pVAD (Impella or TandemHeart) versus IABP in patients who underwent high-risk PCI or with CS. For detailed description of the included studies please see Table 1 and Table 2.
All the included RCTs were at high risk of bias mostly because of open-label nature of the included
Discussion
The use of more robust and sophisticated hemodynamic support devices during complex PCI or for patients with established CS does not seem to have decreased the morbidity and mortality associated with these conditions. Despite the lack of evidence showing superiority of pVAD over IABP, there is a notable shift toward an increased use of the first, especially the Impella, in these clinical scenarios.25 Compared with previous meta-analyses of the topic, our study is the largest and the only one
Acknowledgment
This study did not receive any external funding.
Competing Interest
Dr. Deepak L. Bhatt discloses the following relationships—Advisory Board: Cardax, Elsevier Practice Update Cardiology, Medscape Cardiology, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute), Cleveland Clinic, Duke Clinical Research Institute, Mayo Clinic, Mount
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2022, American Journal of CardiologyCitation Excerpt :In addition, our analysis did not identify an increased risk of stroke or bleeding requiring transfusion with Impella compared with IABP. Our data align with a recent meta-analysis, showing no added bleeding risk with percutaneous ventricular assist devices compared with IABP.18 Improvements in bleeding rates in our study are consistent with recent series of large-bore access devices, where ultrasound-guided access techniques have become the norm in contemporary practice (as seen in transcatheter aortic valve replacement), reducing vascular complications.
Ten-year, single center experience of ambulatory axillary intra-aortic balloon pump support for heart failure
2022, Journal of CardiologyCitation Excerpt :Although percutaneous LVAD technology such as Impella and Tandem heart (Cardiac Assist, Pittsburgh, PA, USA) have become options to support heart failure patients, it has not been proven that these devices provide improved clinical outcomes compared to IABP support [23–26]. A meta-analysis showed that there was no difference in mortality between IABP and percutaneous LVAD for high-risk percutaneous coronary intervention or cardiogenic shock patients, and the use of percutaneous LVAD was associated with more adverse events than IABP [25]. Stroke is a significant complication of axillary IABP.
Infectious complications associated with short-term mechanical circulatory support in urgent heart transplant candidates
2022, Revista Espanola de CardiologiaOutcomes of Impella compared with intra-aortic balloon pump in ST-elevation myocardial infarction complicated by cardiogenic shock
2021, American Heart Journal Plus: Cardiology Research and Practice
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First two co-authors contributed equally.