Author + information
- Regina C. Lee,
- Michael J. Lipinski,
- Muhammad U. Tariq,
- Rebecca Torguson,
- William O. Suddath and
- Ron Waksman
The intra-aortic balloon pump (IABP) and Impella may be used for hemodynamic support during percutaneous coronary interventions (PCI). However, controversy exists regarding its use in patients with acute myocardial infarction (MI). We performed a network meta-analysis of studies in patients with acute MI to compare clinical outcomes with IABP, Impella, and optimal medical therapy (OMT).
MEDLINE/PubMed, Cochrane CENTRAL, and ClinicalTrials.gov were searched for studies assessing Impella and IABP in patients with AMI with or without cardiogenic shock. Network meta-analysis with a Bayesian framework was performed to directly and indirectly compare clinical outcomes at 30 days or closest available. Odds ratios with 95% confidence intervals (OR [95% CIs]) were generated with random-effects models to compare outcomes.
Our analysis included 7 RCTs with 1838 patients who were randomized to IABP (n=908), Impella (n=24), or OMT (n=906), and 2 non-RCTs with 13,539 patients who received IABP (n=956) or OMT (n=12,583). The mean age was 67.4+/-12 years, 78.6% were male, 72.1% had hypertension, 39.1% had diabetes mellitus, and 24.0% had a prior MI. There was no significant difference in all-cause mortality, stroke, or vascular complications. There was a trend towards higher mortality with both IABP and Impella (Figure). Major bleeding was also higher with IABP and Impella although this was not significant (Figure). However, when compared to IABP, Impella trended toward higher major bleeding as well (OR 65.6 [0.14,>1000]).
There is no apparent benefit for the routine use of either device against OMT for patients presenting with AMI. The number of patients included for Impella is very limited, and further studies are needed to elucidate the outcomes, benefits and risks of these devices during PCI for acute MI.