Use of Impella device in cardiogenic shock and its clinical outcomes: A systematic review and meta-analysis
Introduction: Cardiogenic shock (CS) is a life-threatening condition and mechanical circulatory support (MCS) might exert a relevant impact on its clinical course. Among MCS devices, Impella is very promising. Yet, its usefulness is still debated. We performed a meta-analysis of all studies evaluati...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352906722000562 |
| _version_ | 1828748671082037248 |
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| author | Giuseppe Panuccio Giuseppe Neri Lucrezia Maria Macrì Nadia Salerno Salvatore De Rosa Daniele Torella |
| author_facet | Giuseppe Panuccio Giuseppe Neri Lucrezia Maria Macrì Nadia Salerno Salvatore De Rosa Daniele Torella |
| author_sort | Giuseppe Panuccio |
| collection | DOAJ |
| description | Introduction: Cardiogenic shock (CS) is a life-threatening condition and mechanical circulatory support (MCS) might exert a relevant impact on its clinical course. Among MCS devices, Impella is very promising. Yet, its usefulness is still debated. We performed a meta-analysis of all studies evaluating the clinical impact of Impella in CS. Methods: All studies including patients with CS and treated with Impella were included. The primary endpoint was short-term mortality. Secondary endpoints were vascular access complications and major bleeding. Data synthesis was obtained using random-effects metanalysis. Results: Thirty-three studies and 5204 patients were included. Short-term mortality was 47%. Meta-regression analysis showed that patients age (p = 0.01), higher support level (p = 0.004) and pre-PCI insertion (p < 0.001) were significant moderators for the primary endpoint. Vascular access complications were registered in 6.4% of cases, whereas age (p = 0.05) and diabetes (p = 0.007) were significant predictors. Major bleeding occurred in 16.4% of patients. Meta-analysis of the subgroup of studies comparing Impella to IABP showed no significant difference in short-term mortality (RR = 1.08, p = 0.45), while rates of vascular access complications (p < 0.001) or major bleeding (p < 0.001) were significantly higher with Impella. Subgroup and metaregression analyses showed that these results were influenced by lower adoption rates of higher degree of MCS support (p = 0.003), and by higher vascular complications rates (p = 0.014). Conclusions: Our results suggest that the choice of adequate device size, careful patients selection and optimal timing of MCS initiation are key to clinical success with Impella in CS. Large prospective studies are mandatory to confirm these results deriving from retrospective studies. |
| first_indexed | 2024-04-14T05:17:46Z |
| format | Article |
| id | doaj.art-be348cda0e09402eb48eac9cf0bfb4c9 |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-04-14T05:17:46Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-be348cda0e09402eb48eac9cf0bfb4c92022-12-22T02:10:19ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672022-06-0140101007Use of Impella device in cardiogenic shock and its clinical outcomes: A systematic review and meta-analysisGiuseppe Panuccio0Giuseppe Neri1Lucrezia Maria Macrì2Nadia Salerno3Salvatore De Rosa4Daniele Torella5Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, ItalyDepartment of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, ItalyDepartment of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, ItalyDepartment of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, ItalyDepartment of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, ItalyDepartment of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy; Corresponding author at: Cardiovascular Institute and Telemedicine University Center, Materdomini University Hospital, Magna Graecia University, 88100, Italy. Tel.: +39 0961 369 41 85.Introduction: Cardiogenic shock (CS) is a life-threatening condition and mechanical circulatory support (MCS) might exert a relevant impact on its clinical course. Among MCS devices, Impella is very promising. Yet, its usefulness is still debated. We performed a meta-analysis of all studies evaluating the clinical impact of Impella in CS. Methods: All studies including patients with CS and treated with Impella were included. The primary endpoint was short-term mortality. Secondary endpoints were vascular access complications and major bleeding. Data synthesis was obtained using random-effects metanalysis. Results: Thirty-three studies and 5204 patients were included. Short-term mortality was 47%. Meta-regression analysis showed that patients age (p = 0.01), higher support level (p = 0.004) and pre-PCI insertion (p < 0.001) were significant moderators for the primary endpoint. Vascular access complications were registered in 6.4% of cases, whereas age (p = 0.05) and diabetes (p = 0.007) were significant predictors. Major bleeding occurred in 16.4% of patients. Meta-analysis of the subgroup of studies comparing Impella to IABP showed no significant difference in short-term mortality (RR = 1.08, p = 0.45), while rates of vascular access complications (p < 0.001) or major bleeding (p < 0.001) were significantly higher with Impella. Subgroup and metaregression analyses showed that these results were influenced by lower adoption rates of higher degree of MCS support (p = 0.003), and by higher vascular complications rates (p = 0.014). Conclusions: Our results suggest that the choice of adequate device size, careful patients selection and optimal timing of MCS initiation are key to clinical success with Impella in CS. Large prospective studies are mandatory to confirm these results deriving from retrospective studies.http://www.sciencedirect.com/science/article/pii/S2352906722000562Cardiogenic shockImpellaHemodynamic supportMechanical circulatory supportIABP |
| spellingShingle | Giuseppe Panuccio Giuseppe Neri Lucrezia Maria Macrì Nadia Salerno Salvatore De Rosa Daniele Torella Use of Impella device in cardiogenic shock and its clinical outcomes: A systematic review and meta-analysis International Journal of Cardiology: Heart & Vasculature Cardiogenic shock Impella Hemodynamic support Mechanical circulatory support IABP |
| title | Use of Impella device in cardiogenic shock and its clinical outcomes: A systematic review and meta-analysis |
| title_full | Use of Impella device in cardiogenic shock and its clinical outcomes: A systematic review and meta-analysis |
| title_fullStr | Use of Impella device in cardiogenic shock and its clinical outcomes: A systematic review and meta-analysis |
| title_full_unstemmed | Use of Impella device in cardiogenic shock and its clinical outcomes: A systematic review and meta-analysis |
| title_short | Use of Impella device in cardiogenic shock and its clinical outcomes: A systematic review and meta-analysis |
| title_sort | use of impella device in cardiogenic shock and its clinical outcomes a systematic review and meta analysis |
| topic | Cardiogenic shock Impella Hemodynamic support Mechanical circulatory support IABP |
| url | http://www.sciencedirect.com/science/article/pii/S2352906722000562 |
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