Batsides George, Massaro Joe, Cheung Anson, Soltesz Edward, Ramzy Danny, Anderson Mark B
Department of Biostatistics, Boston University School of Public Health, Boston, MA USA.
Saint Paul's Hospital, University of British Columbia, Vancouver, BC Canada.
Innovations (Phila). 2018 Jul/Aug;13(4):254-260. doi: 10.1097/IMI.0000000000000535.
The aim of the study was to comprehensively summarize the survival outcomes and complications of Impella 5.0 (Abiomed Inc, Danvers, MA USA) use in patients with cardiogenic shock (CS).
We performed a literature review for relevant studies by searching in Medline, Medline In-Process, EMBASE, and the CENTRAL bibliographic databases on April 30, 2017. Nonoverlapping studies with 10 patients or more supported for cardiogenic shock with Impella 5.0 or Impella left direct were included. Data on patient characteristics, indication of support, and outcomes were extracted. A random effect was used to pool the various outcomes.
This meta-analysis included six studies totaling 163 patients (mean ± SD age = 56.3 ± 12.0, male 81%). Indications for support included 88 (54.0%) for acute on chronic decompensated heart failure, 35 (21.5%) for postcardiotomy cardiogenic shock, 27 (16.6%) for acute myocardial infarction complicated by cardiogenic shock, and, 13 (8.0%) for cardiogenic shock due to other reasons. Survival to next therapy was 73.5% in patients supported for acute on chronic decompensated heart failure. The survival to device explant among patients supported for postcardiotomy cardiogenic shock or acute myocardial infarction complicated by cardiogenic shock was 90.2%, and of those, myocardial recovery was achieved in 73.8%. The overall estimated survival to discharge, 30, 180, and 365 days was 73.5%, 72.6%, 62.7%, and 58.4%, respectively. Patients supported for postcardiotomy cardiogenic shock had the highest heart recovery among survivors to explant (92.1%) and highest survival at 30 (89.5%) and 365 days (69.5%).
Impella 5.0/LD is associated with favorable survival outcomes and higher rate of myocardial recovery in patients with cardiogenic shock.
本研究旨在全面总结使用Impella 5.0（美国马萨诸塞州丹弗斯市Abiomed公司）治疗心源性休克（CS）患者的生存结局和并发症。
2017年4月30日，我们在Medline、Medline In-Process、EMBASE和CENTRAL书目数据库中检索相关研究进行文献综述。纳入10例或更多患者使用Impella 5.0或Impella左心直接支持治疗心源性休克的非重叠研究。提取患者特征、支持指征和结局的数据。采用随机效应合并各种结局。
该荟萃分析纳入了6项研究，共163例患者（平均±标准差年龄=56.3±12.0岁，男性占81%）。支持指征包括88例（54.0%）慢性失代偿性心力衰竭急性发作、35例（21.5%）心脏术后心源性休克、27例（16.6%）急性心肌梗死合并心源性休克以及13例（8.0%）其他原因导致的心源性休克。慢性失代偿性心力衰竭急性发作患者接受支持治疗后存活至下一治疗阶段的比例为73.5%。心脏术后心源性休克或急性心肌梗死合并心源性休克患者中，装置取出时的存活率为90.2%，其中73.8%实现了心肌恢复。出院、30天、180天和365天的总体估计存活率分别为73.5%、72.6%、62.7%和58.4%。心脏术后心源性休克患者在装置取出存活者中心脏恢复率最高（92.1%），30天（89.5%）和365天（69.5%）的存活率也最高。
Impella 5.0/LD与心源性休克患者良好的生存结局和较高的心肌恢复率相关。
