Timing of mechanical circulatory support during primary angioplasty in acute myocardial infarction and cardiogenic shock: Systematic review and meta‐analysis

Abstract

Objectives: We aim to define whether the timing of microaxial left ventricular assist device (IMLVAD) implantation might impact on mortality in acute myocardial infarction (AMI) cardiogenic shock (CS) patients who underwent primary percutaneous coronary intervention (PPCI).Background: Despite the widespread use of PPCI, mortality in patients with AMI and CS remains high. Mechanical circulatory support is a promising bridge to recovery strategy, but evidence on its benefit is still inconclusive and the optimal timing of its utilization remains poorly explored. Methods:We compared clinical outcomes of upstream IMLVAD use before PPCI versus bailout use after PPCI in patients with AMI CS. A systematic review and meta-analysis of studies comparing the two strategies were performed. Effect size was reported as odds ratio (OR) using bailout as reference group and a random effect model was used. Study-level risk estimates were pooled through the generic inverse variance method (random effect model).Results: A total of 11 observational studies were identified, including a pooled population of 6759 AMI-CS patients. Compared with a bailout approach, upstream IMLVAD was associated with significant reduction of 30-day

Protected cardiac surgery: strategic mechanical circulatory support to improve postcardiotomy mortality

“…(1) AMI-cardiogenic shock (AMI-CS) [34,35]: Percutaneous coronary intervention (PCI) is the cornerstone of treatment for acute myocardial infarction complicated by cardiogenic shock (AMI-CS). Reducing the time from initial hospital presentation to balloon inflation (door-toballoon time) has long been recognized as a critical factor in improving patient outcomes, with a traditional target of less than 90 min.…”

Timing and treatment strategies according to SCAI classification in cardiogenic shock

“…In translational studies, LV unloading with Impella during coronary occlusion, even when prolonging ischaemia time, has been associated with reduced myocardial oxygen demand, reduced LV end-systolic wall stress, and reduction in infarct size compared with immediate revascularization. 12–14 Several registry-based studies and meta-analyses of these studies suggest higher survival rates in AMI-CS when Impella is placed before revascularization, rather than in patients where Impella is placed after percutaneous coronary intervention (PCI) 15–20 although not all. 21 However, the level of evidence is low as the data are subject to significant selection bias.…”

Código shock cardiogénico 2023. Documento de expertos para una organización multidisciplinaria que permita una atención de calidad

“…Dicho estudio evaluó la supervivencia 11 . Recientemente, un metanálisis que incluyó a 6.700 pacientes confirmó que la asistencia mecánica con Impella previo a la angioplastia reducía de forma drástica la mortalidad a 30 días 27 . Esta estrategia se está validando por el DanGer shock trial, actualmente en fase de inclusión 28 .…”