PMID- 35570152
OWN - NLM
STAT- MEDLINE
DCOM- 20220816
LR  - 20220823
IS  - 1878-0938 (Electronic)
IS  - 1878-0938 (Linking)
VI  - 42
DP  - 2022 Sep
TI  - Efficacy of Mechanical Circulatory Support Used Before Versus After Primary 
      Percutaneous Coronary Intervention in Patients with Cardiogenic Shock From 
      ST-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis.
PG  - 74-83
LID - S1553-8389(22)00231-7 [pii]
LID - 10.1016/j.carrev.2022.05.002 [doi]
AB  - BACKGROUND: Optimal timing to initiate mechanical circulatory support (MCS) in 
      patients with ST-elevation myocardial infarction (STEMI) complicated by 
      cardiogenic shock (CS) remains unclear with studies showing conflicting results 
      on whether to start before or after primary percutaneous coronary intervention 
      (PPCI). This study aims to examine the association between mortality and MCS 
      initiated before vs after PPCI in patients with STEMI complicated by CS. METHODS: 
      We systematically searched PubMed, Embase, and Scopus for abstracts and full-text 
      articles from inception to October 2021. Studies were included if they evaluated 
      the association of mortality in patients who initiated MCS (specifically 
      intra-aortic balloon pump (IABP), Impella, and venoarterial extracorporeal 
      membrane oxygenation (VA-ECMO)) before PPCI versus after PPCI, specifically in 
      patients with STEMI complicated by CS. Data were integrated using the 
      random-effects models. RESULTS: Ten studies involving 1,352 patients (956, 203, 
      and 193 patients underwent IABP, Impella, and VA-ECMO respectively) with STEMI 
      complicated by CS were included. There was no difference in mortality using IABP 
      before or after PPCI ([OR] 1.77, 95% CI 0.77-1.61, I2 = 27%, p = 0.57). 
      Nevertheless, Impella and VA-ECMO started before PPCI were significantly 
      associated with a reduced risk of mortality compared to that started after PPCI 
      ([OR] 0.49, 95% CI 0.26-0.92, I2 = 0%, p = 0.03 and [OR] 0.29, 95% CI 0.14-0.62, 
      I2 = 0%, p = 0.001, respectively). CONCLUSIONS: In patients with STEMI 
      complicated by CS undergoing PPCI, the use of IMPELLA or VA-ECMO prior to PPCI 
      significantly decreased mortality, in contrast to IABP, in which no difference in 
      mortality was found between using it before or after PPCI. More rigorous studies 
      are needed to clarify this association.
CI  - Copyright (c) 2022 Elsevier Inc. All rights reserved.
FAU - Del Rio-Pertuz, Gaspar
AU  - Del Rio-Pertuz G
AD  - Department of Internal Medicine, Texas Tech University Health Sciences Center, 
      Lubbock, TX, USA. Electronic address: gaspar.del-rio-pertuz@ttuhsc.edu.
FAU - Benjanuwattra, Juthipong
AU  - Benjanuwattra J
AD  - Department of Internal Medicine, Texas Tech University Health Sciences Center, 
      Lubbock, TX, USA.
FAU - Juarez, Michel
AU  - Juarez M
AD  - Center for Research in Indigenous Health, Wuqu' Kawoq|Maya Health Alliance, 2a 
      Avenida 3-48 Zona 3, Barrio Patacabaj, Tecpan, Chimaltenango, Guatemala.
FAU - Mekraksakit, Poemlarp
AU  - Mekraksakit P
AD  - Department of Internal Medicine, Texas Tech University Health Sciences Center, 
      Lubbock, TX, USA.
FAU - Argueta-Sosa, Erwin
AU  - Argueta-Sosa E
AD  - Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock, 
      TX, USA.
FAU - Ansari, Mohammad M
AU  - Ansari MM
AD  - Division of Cardiology, Texas Tech University Health Sciences Center, Lubbock, 
      TX, USA.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20220506
PL  - United States
TA  - Cardiovasc Revasc Med
JT  - Cardiovascular revascularization medicine : including molecular interventions
JID - 101238551
SB  - IM
CIN - Cardiovasc Revasc Med. 2022 Sep;42:84-85. PMID: 35697640
MH  - *Heart-Assist Devices/adverse effects
MH  - Humans
MH  - Intra-Aortic Balloon Pumping/methods
MH  - *Percutaneous Coronary Intervention
MH  - *ST Elevation Myocardial Infarction/diagnostic imaging/therapy
MH  - Shock, Cardiogenic/diagnosis/etiology/therapy
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Cardiogenic shock
OT  - Mechanical circulatory support
OT  - ST-elevation myocardial infarction
COIS- Declaration of competing interest The authors report no conflict of interest or 
      any source of financial support.
EDAT- 2022/05/16 06:00
MHDA- 2022/08/17 06:00
CRDT- 2022/05/15 22:13
PHST- 2022/03/22 00:00 [received]
PHST- 2022/04/17 00:00 [revised]
PHST- 2022/05/02 00:00 [accepted]
PHST- 2022/05/16 06:00 [pubmed]
PHST- 2022/08/17 06:00 [medline]
PHST- 2022/05/15 22:13 [entrez]
AID - S1553-8389(22)00231-7 [pii]
AID - 10.1016/j.carrev.2022.05.002 [doi]
PST - ppublish
SO  - Cardiovasc Revasc Med. 2022 Sep;42:74-83. doi: 10.1016/j.carrev.2022.05.002. Epub 
      2022 May 6.