Comparative Effectiveness of Mechanical Circulatory Support Devices in Patients Undergoing Complex High-Risk Percutaneous Coronary Interventions (CHIP): A Systematic Review and Network Meta-Analysis.

BACKGROUND

Patients undergoing complex high-risk percutaneous coronary interventions (CHIP) are prone to hemodynamic instability, and the optimal mechanical circulatory support (MCS) strategy for this population remains unclear.

AIMS

This systematic review and network meta-analysis aimed to compare the short-term safety and efficacy of various MCS strategies in CHIP.

METHODS

We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library for studies comparing different MCS strategies in CHIP patients with short-term endpoints. The primary efficacy outcome was in-hospital or 30-day mortality. Safety outcomes included MCS-related complications, specifically bleeding and stroke. The MCS strategies evaluated were intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (VA-ECMO), IMPELLA, VA-ECMO + IABP, and VA-ECMO + IMPELLA (ECPELLA). A random-effects Bayesian network meta-analysis was performed, integrating both direct and indirect comparisons.

RESULTS

Twelve studies involving a total of 75,274 patients were included. Both IABP (OR: 0.33; 95% CI: 0.13-0.91) and IMPELLA (OR: 0.44; 95% CI: 0.21-0.96) were associated with significantly lower short-term mortality compared to VA-ECMO. No significant differences were observed among other strategies. Rank probability analysis suggested that IABP had the highest probability of being the most effective strategy for reducing short-term mortality. Regarding safety outcomes, IABP was associated with a significantly lower bleeding risk compared to VA-ECMO (OR: 0.18; 95% CI: 0.04-0.82), VA-ECMO + IABP (OR: 0.18; 95% CI: 0.03-0.87), ECPELLA (OR: 0.12; 95% CI: 0.02-0.70), and IMPELLA (OR: 0.21; 95% CI: 0.05-0.75), with no significant difference in stroke risk across strategies.

CONCLUSIONS

Among available MCS strategies for CHIP patients, IABP appears to be associated with improved short-term survival and a lower risk of bleeding, without an increased risk of stroke. These findings support IABP as a potentially preferable support option, warranting further validation in prospective clinical trials.