Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.
Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy.
Int J Cardiol. 2022 Sep 1;362:47-54. doi: 10.1016/j.ijcard.2022.05.011. Epub 2022 May 6.
The timing of hemodynamic support in acute myocardial infarction complicated by cardiogenic shock (AMICS) has yet to be defined. The aim of this meta-analysis was to evaluate the impact of timing of Impella initiation on early and midterm mortality.
A systematic literature review and meta-analysis was conducted using PubMed and Cochrane databases. All studies reporting short-term mortality rates and timing of Impella placement in AMICS were included. Meta-regression analysis and sensitivity analysis were performed on the primary endpoint, short-term mortality (≤30 days), and secondary endpoints (midterm mortality, device-related bleeding, and limb ischemia).
Of 1289 studies identified, 13 studies (6810 patients; 2970 patients identified as receiving Impella pre-PCI and 3840 patients receiving Impella during/post-PCI) were included in this analysis. Median age was 63.8 years (IQR 63-65.7); 76% of patients were male, and a high prevalence of cardiovascular risk factors was noted across the entire population. Short-term mortality was significantly reduced in those receiving pre-PCI vs. during/post-PCI Impella support (37.2% vs 53.6%, RR 0.7; CI 0.56-0.88). Midterm mortality was also lower in the pre-PCI Impella group (47.9% vs 73%, RR 0.81; CI 0.68-0.97). The rate of device-related bleeding (RR 1.05; CI 0.47-2.33) and limb ischemia (RR 1.6; CI 0.63-2.15) were similar between the two groups.
This analysis suggests that Impella placement prior to PCI in AMICS may have a positive impact on short- and midterm mortality compared with post-PCI, with similar safety outcomes. Due to the observational nature of the included studies, further studies are needed to confirm this hypothesis (CRD42022300372).
急性心肌梗死合并心源性休克（AMI-CS）患者的血流动力学支持时机尚未确定。本荟萃分析旨在评估 Impella 启动时机对早期和中期死亡率的影响。
通过 PubMed 和 Cochrane 数据库进行系统文献回顾和荟萃分析。纳入所有报告 AMI-CS 短期死亡率和 Impella 放置时机的研究。对主要终点（30 天内死亡率）和次要终点（中期死亡率、器械相关出血和肢体缺血）进行荟萃回归分析和敏感性分析。
在 1289 项研究中，有 13 项研究（6810 例患者；2970 例患者被确定为接受 PCI 前的 Impella，3840 例患者在 PCI 期间/后接受 Impella）被纳入本分析。中位年龄为 63.8 岁（IQR 63-65.7）；76%的患者为男性，整个人群均存在较高的心血管危险因素。与接受 PCI 期间/后 Impella 支持的患者相比，接受 PCI 前 Impella 支持的患者短期死亡率显著降低（37.2%比 53.6%，RR 0.7；95%CI 0.56-0.88）。PCI 前 Impella 组的中期死亡率也较低（47.9%比 73%，RR 0.81；95%CI 0.68-0.97）。两组器械相关出血（RR 1.05；95%CI 0.47-2.33）和肢体缺血（RR 1.6；95%CI 0.63-2.15）的发生率相似。
与 PCI 后相比，AMI-CS 患者在 PCI 前放置 Impella 可能对短期和中期死亡率产生积极影响，且安全性结局相似。由于纳入研究的观察性质，需要进一步研究来证实这一假设（CRD42022300372）。
