Butt, Zaran;
Sharif, Saad;
Ahmad, Mohammed;
Daly, Michael J;
O'Neill, James;
Gentry-Maharaj, Aleksandra;
Godolphin, Peter J;
(2025)
Mechanical circulatory support for infarct-related cardiogenic shock: a systematic review, pairwise and network meta-analysis.
European Heart Journal Open
, 5
(4)
, Article oeaf091. 10.1093/ehjopen/oeaf091.
Preview |
Text
Butt_EurHJOpen_2025.pdf - Published Version Download (1MB) | Preview |
Abstract
Aims Mortality from cardiogenic shock complicating acute myocardial infarction (AMI-CS) remains high, despite the increasing mechanical circulatory support (MCS) use in clinical practice. Methods and results 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, n = 748 patients), veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) vs. No VA-ECMO (four trials, n = 568 patients), percutaneous ventricular assist device (pVAD) vs. No pVAD (six trials, n = 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 P (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. Conclusion 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.
| Type: | Article |
|---|---|
| Title: | Mechanical circulatory support for infarct-related cardiogenic shock: a systematic review, pairwise and network meta-analysis |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/ehjopen/oeaf091 |
| Publisher version: | https://doi.org/10.1093/ehjopen/oeaf091 |
| Language: | English |
| Additional information: | © The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, Cardiogenic shock, Mechanical circulatory support, Veno-arterial extra-corporeal membrane oxygenation, Percutaneous ventricular assist device, Intra-aortic balloon pump, Myocardial infarction, INTRAAORTIC BALLOON COUNTERPULSATION, MYOCARDIAL-INFARCTION, ASSIST DEVICE, TRIAL |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL EGA Institute for Womens Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Inst of Clinical Trials and Methodology > MRC Clinical Trials Unit at UCL |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10212994 |
Archive Staff Only
 |
View Item |
