Frye Jesse, Tao Michael, Gupta Shivani, Gier Chad, Masson Ravi, Rahman Tahmid, Bench Travis, Mann Noelle, Tam Edlira
Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA.
Department of Medicine, Division of Cardiology, Stony Brook University Hospital, Stony Brook, NY, USA.
Cardiovasc Revasc Med. 2025 Jan;70:23-33. doi: 10.1016/j.carrev.2024.06.016. Epub 2024 Jun 21.
Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is a major cause of morbidity and mortality. Although mechanical circulatory support (MCS) is an increasingly utilized therapeutic option in AMI-CS, studies evaluating the efficacy and safety of different forms of MCS have yielded conflicting results. This systematic review and meta-analysis aims to evaluate the safety and efficacy of different forms of MCS.
A database search was performed for studies reporting on the association of different forms of MCS with clinical outcomes in patients with AMI-CS. The primary efficacy endpoints were short term (≤30 days) and long term (>30 days) all-cause mortality. Secondary efficacy endpoints included recurrent AMI, cardiovascular (CV) mortality, device-related limb complications, moderate to severe bleeding events, and cerebrovascular accidents (CVA).
2752 patients with AMI-CS met inclusion criteria. Results were available comparing ECMO to other MCS or medical therapy alone, comparing IABP to medical therapy alone, and comparing pLVAD to IABP. Use of ECMO was not associated with lower risk of 30-day or long-term mortality compared to pVAD or standard medical therapy with or without IABP placement but was associated with higher risk of device-related limb complications and moderate to severe bleeding compared to pVAD. IABP use was not associated with a lower risk of 30 day or long-term mortality but was associated with higher risk of recurrent AMI and moderate to severe bleeding compared to medical therapy. Compared to IABP, pVAD use was associated with lower risk of CV mortality but not recurrent AMI. pVAD was associated with a higher risk of device-related limb complications and moderate to severe bleeding compared to IABP use.
Use of ECMO or IABP in patients with AMI-CS is not associated with significant improvement in mortality. pVAD is associated with a lower risk of CV mortality. All MCS types are associated with increased risk of complications. Additional high-quality studies are needed to determine the optimal MCS therapy for patients with AMI-CS.
急性心肌梗死合并心源性休克（AMI-CS）是发病和死亡的主要原因。尽管机械循环支持（MCS）在AMI-CS中的应用越来越广泛，但评估不同形式MCS的疗效和安全性的研究结果相互矛盾。本系统评价和荟萃分析旨在评估不同形式MCS的安全性和疗效。
对报道不同形式MCS与AMI-CS患者临床结局相关性的研究进行数据库检索。主要疗效终点为短期（≤30天）和长期（>30天）全因死亡率。次要疗效终点包括复发性AMI、心血管（CV）死亡率、与装置相关的肢体并发症、中度至重度出血事件和脑血管意外（CVA）。
2752例AMI-CS患者符合纳入标准。有结果比较了体外膜肺氧合（ECMO）与其他MCS或单纯药物治疗，比较了主动脉内球囊反搏（IABP）与单纯药物治疗，以及比较了经皮左心室辅助装置（pLVAD）与IABP。与pVAD或有或无IABP植入的标准药物治疗相比，使用ECMO与30天或长期死亡率降低无关，但与pVAD相比，与装置相关的肢体并发症和中度至重度出血风险更高。使用IABP与30天或长期死亡率降低无关，但与复发性AMI和中度至重度出血风险高于药物治疗相关。与IABP相比，使用pVAD与CV死亡率降低有关，但与复发性AMI无关。与使用IABP相比，pVAD与装置相关的肢体并发症和中度至重度出血风险更高。
在AMI-CS患者中使用ECMO或IABP与死亡率的显著改善无关。pVAD与CV死亡率降低有关。所有类型的MCS都与并发症风险增加有关。需要更多高质量的研究来确定AMI-CS患者的最佳MCS治疗方案。
