Timing of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: A systematic review and meta-analysis
Background: Acute myocardial infarction (AMI) complicated by cardiogenic shock has a high mortality rate. Mechanical circulatory support (MCS) has been increasingly used; however, the optimal timing for MCS insertion remains uncertain. This study aimed to evaluate outcomes of pre-percutaneous corona...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-02-01
|
| Series: | American Heart Journal Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666602225000096 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1825199268565090304 |
|---|---|
| author | Tanawat Attachaipanich Suthinee Attachaipanich Kotchakorn Kaewboot |
| author_facet | Tanawat Attachaipanich Suthinee Attachaipanich Kotchakorn Kaewboot |
| author_sort | Tanawat Attachaipanich |
| collection | DOAJ |
| description | Background: Acute myocardial infarction (AMI) complicated by cardiogenic shock has a high mortality rate. Mechanical circulatory support (MCS) has been increasingly used; however, the optimal timing for MCS insertion remains uncertain. This study aimed to evaluate outcomes of pre-percutaneous coronary intervention (PCI) vs post-PCI MCS insertion in AMI patients with cardiogenic shock. Methods: A systematic search using 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to October 25, 2024. Studies comparing outcomes of MCS insertion pre-PCI vs post-PCI in this setting were included. Results: There were 36 studies with a total of 6218 participants were included in this meta-analysis, using a random-effects model. Most of the included studies were non-randomized and retrospective. Early MCS insertion (prior to PCI) was associated with a lower risk of in-hospital mortality compared to late insertion (post-PCI), with an odds ratio (OR) of 0.46 (95%CI 0.36 to 0.57), p < 0.01. Subgroup analysis by MCS type (IABP, Impella, and ECMO) demonstrated that early insertion prior to PCI significantly reduced in-hospital mortality, regardless of the MCS type. Early MCS insertion prior to PCI was also associated with lower 30-day mortality (OR 0.62, (95%CI 0.43 to 0.89), p = 0.01) and 6-month mortality (OR 0.53, (95%CI 0.34 to 0.83), p = 0.01) compared to late insertion. There was no difference in 1-year mortality or in MCS-related complications. Conclusions: Early MCS insertion prior to PCI is potentially associated with reduced in-hospital, 30-day, and 6-month mortality compared to post-PCI insertion in AMI patients with cardiogenic shock. |
| format | Article |
| id | doaj-art-77d623bbd3dc4fc8b4591197c3d306c2 |
| institution | Kabale University |
| issn | 2666-6022 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | American Heart Journal Plus |
| spelling | doaj-art-77d623bbd3dc4fc8b4591197c3d306c22025-02-08T05:01:23ZengElsevierAmerican Heart Journal Plus2666-60222025-02-0150100506Timing of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: A systematic review and meta-analysisTanawat Attachaipanich0Suthinee Attachaipanich1Kotchakorn Kaewboot2Department of Internal Medicine, University of Missouri-Kansas City School of Medicine, Kansas City 64110, MO, USAGraduate School of Science, Osaka University, Osaka 565-0871, JapanDivision of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; Corresponding author.Background: Acute myocardial infarction (AMI) complicated by cardiogenic shock has a high mortality rate. Mechanical circulatory support (MCS) has been increasingly used; however, the optimal timing for MCS insertion remains uncertain. This study aimed to evaluate outcomes of pre-percutaneous coronary intervention (PCI) vs post-PCI MCS insertion in AMI patients with cardiogenic shock. Methods: A systematic search using 4 databases, including PubMed, Embase, Web of Science, and Cochrane CENTRAL, was conducted from inception to October 25, 2024. Studies comparing outcomes of MCS insertion pre-PCI vs post-PCI in this setting were included. Results: There were 36 studies with a total of 6218 participants were included in this meta-analysis, using a random-effects model. Most of the included studies were non-randomized and retrospective. Early MCS insertion (prior to PCI) was associated with a lower risk of in-hospital mortality compared to late insertion (post-PCI), with an odds ratio (OR) of 0.46 (95%CI 0.36 to 0.57), p < 0.01. Subgroup analysis by MCS type (IABP, Impella, and ECMO) demonstrated that early insertion prior to PCI significantly reduced in-hospital mortality, regardless of the MCS type. Early MCS insertion prior to PCI was also associated with lower 30-day mortality (OR 0.62, (95%CI 0.43 to 0.89), p = 0.01) and 6-month mortality (OR 0.53, (95%CI 0.34 to 0.83), p = 0.01) compared to late insertion. There was no difference in 1-year mortality or in MCS-related complications. Conclusions: Early MCS insertion prior to PCI is potentially associated with reduced in-hospital, 30-day, and 6-month mortality compared to post-PCI insertion in AMI patients with cardiogenic shock.http://www.sciencedirect.com/science/article/pii/S2666602225000096Cardiogenic shockMechanical circulation supportMyocardial infarction |
| spellingShingle | Tanawat Attachaipanich Suthinee Attachaipanich Kotchakorn Kaewboot Timing of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: A systematic review and meta-analysis American Heart Journal Plus Cardiogenic shock Mechanical circulation support Myocardial infarction |
| title | Timing of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: A systematic review and meta-analysis |
| title_full | Timing of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: A systematic review and meta-analysis |
| title_fullStr | Timing of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: A systematic review and meta-analysis |
| title_full_unstemmed | Timing of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: A systematic review and meta-analysis |
| title_short | Timing of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: A systematic review and meta-analysis |
| title_sort | timing of mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock a systematic review and meta analysis |
| topic | Cardiogenic shock Mechanical circulation support Myocardial infarction |
| url | http://www.sciencedirect.com/science/article/pii/S2666602225000096 |
| work_keys_str_mv | AT tanawatattachaipanich timingofmechanicalcirculatorysupportinacutemyocardialinfarctioncomplicatedbycardiogenicshockasystematicreviewandmetaanalysis AT suthineeattachaipanich timingofmechanicalcirculatorysupportinacutemyocardialinfarctioncomplicatedbycardiogenicshockasystematicreviewandmetaanalysis AT kotchakornkaewboot timingofmechanicalcirculatorysupportinacutemyocardialinfarctioncomplicatedbycardiogenicshockasystematicreviewandmetaanalysis |