A Meta-analysis Of Impella Versus IABP For The Supportive Treatment With High Risk PCI And Cardiogenic Shock

Objective:Intra-aortic balloon counterpulsation is widely used for high-risk percutaneous coronary interventions and for circulatory support in patients with acute myocardial infarction combined with cardiogenic shock.Studies have shown that performing intra-aortic balloon counterpulsation support is not effective in improving the short-term survival of these patients.However,IABP is still the most common circulatory assist device in the country,and Impella is a percutaneous ventricular assist device that allows for the rapid deployment of advanced mechanical circulatory support in these patients.However,its safety and efficacy in the population is controversial.Therefore,our aim was to compare the efficacy and safety of the use of Impella or IABP in patients undergoing high-risk PCI and cardiogenic shock through a meta-analysis and to explore relevant factors that may influence the outcome of the study.Methods:Databases such as Pubmed,Embase,the Web of science core,CNKI databases were searched for the period from their creation to January 2023.Relevant randomized trials and observational studies were identified and meta-analysis was performed using Review Maneger 5.4 software.Primary outcome indicators were short-term mortality(defined as mortality within 30 days),and secondary outcome indicators included major bleeding events,vascular complications,ischemic and hemorrhagic stroke,sepsis,and recurrent heart attack and were analyzed for patient characteristics such as ejection fraction.Results:The study included 10 papers for Meta-analysis,the included papers were published from 2008-2020,and included 1377 cases,including 661 cases in the Impella group and 716 cases in the IABP group.the results of Meta-analysis suggested that:1.there was no statistical difference between Impella and IABP in the effect on mortality,stroke,and recurrent heart attack within 30 days in patients2.patients in the Impella group had more major bleeding events(OR = 2.04,95% CI[1.45,2.87],P < 0.0001),vascular complications(OR = 2.92,95% CI [1.59,5.37],P = 0.0005)and sepsis(OR = 1.64,95% CI [1.11.2.40],P = 0.01);3.in baseline characteristics,patients in the Impella group had a lower ejection fraction compared to controls(MD =-3.01,95% CI [-5.14,-0.88],P = 0.006).Conclusion:(1)In patients with cardiogenic shock and high-risk PCI,the use of Impella was safe compared with IABP,although it failed to demonstrate a short-term survival advantage;(2)The risk of bleeding events,vascular complications,and sepsis was higher in the Impella group than in the control group,with no significant difference in the incidence of stroke and recurrent myocardial infarction events;(3)The failure to demonstrate an advantage in the Impella group versus the control group may be due to selection bias,such as lower ejection fraction in patients in the Impella group compared with the control group,rather than a true difference in treatment effect.