Butt Zaran, Sharif Saad, Ahmad Mohammed, Daly Michael J, O'Neill James, Gentry-Maharaj Aleksandra, Godolphin Peter J
MRC Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, WC1V 6LJ London, UK.
Department of Cardiology, Connolly Hospital, Blanchardstown, D15 X40D Dublin, Ireland.
Eur Heart J Open. 2025 Jul 29;5(4):oeaf091. doi: 10.1093/ehjopen/oeaf091. eCollection 2025 Jul.
Mortality from cardiogenic shock complicating acute myocardial infarction (AMI-CS) remains high, despite the increasing mechanical circulatory support (MCS) use in clinical practice.
We undertook a systematic review and meta-analysis of trials assessing MCS in adults with AMI-CS. We searched Medline, EMBASE, CENTRAL, Web of Science, and Scopus from inception to May 2024. We evaluated the effect of each intervention on early mortality using a random-effects network meta-analysis of odds ratios (ORs). Safety outcomes included stroke, bleeding, and sepsis. Fourteen trials randomizing 1858 patients were included: intra-aortic balloon pump (IABP) vs. medical therapy (four trials, = 748 patients), veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) vs. No VA-ECMO (four trials, = 568 patients), percutaneous ventricular assist device (pVAD) vs. No pVAD (six trials, = 542 patients). No MCS device showed a significant effect on early mortality vs. initial medical therapy {IABP (OR 0.87, 95% CI 0.66-1.15), VA-ECMO (OR 0.91, 95% CI 0.65-1.27), pVAD (OR 0.80, 95% CI 0.56-1.14), and (inconsistency) = 0.76}. VA-ECMO and pVAD were associated with increased major bleeding [OR 2.81 (95% CI 1.68-4.71) and OR 5.13 (95% CI 1.87-14.04), respectively]. Higher rates of stroke and sepsis were noted with pVAD. No significant safety concerns were identified with IABP.
The mortality benefit of MCS devices in AMI-CS remains uncertain. Using such devices may be associated with increased risks, including major bleeding, stroke, and sepsis. Current evidence does not support the routine use of MCS devices in the management of AMI-CS.
尽管临床实践中机械循环支持（MCS）的使用日益增多，但急性心肌梗死合并心源性休克（AMI-CS）的死亡率仍然很高。
我们对评估成人AMI-CS中MCS的试验进行了系统评价和荟萃分析。我们检索了从创刊到2024年5月的Medline、EMBASE、CENTRAL、科学网和Scopus。我们使用比值比（OR）的随机效应网络荟萃分析评估了每种干预措施对早期死亡率的影响。安全性结局包括中风、出血和败血症。纳入了14项随机分配1858例患者的试验：主动脉内球囊反搏（IABP）与药物治疗（4项试验，n = 748例患者），静脉-动脉体外膜肺氧合（VA-ECMO）与非VA-ECMO（4项试验，n = 568例患者），经皮心室辅助装置（pVAD）与非pVAD（6项试验，n = 542例患者）。与初始药物治疗相比，没有MCS装置显示出对早期死亡率有显著影响{IABP（OR 0.87，95%CI 0.66-1.15），VA-ECMO（OR 0.91，95%CI 0.65-1.27），pVAD（OR 0.80，95%CI 0.56-1.14），I²（异质性）= 0.76}。VA-ECMO和pVAD与大出血增加相关[分别为OR 2.81（95%CI 1.68-4.71）和OR 5.13（95%CI 1.87-14.04）]。pVAD的中风和败血症发生率较高。IABP未发现明显的安全问题。
MCS装置在AMI-CS中的死亡率获益仍不确定。使用此类装置可能会增加风险，包括大出血、中风和败血症。目前的证据不支持在AMI-CS管理中常规使用MCS装置。
