A systematic literature review and meta-analysis of impella devices used in cardiogenic shock and high risk percutaneous coronary interventions
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Key result
Impella devices demonstrated a pooled 90-day survival rate of 62.6% in cardiogenic shock and a 30-day survival rate of 92.2% in high-risk percutaneous coronary intervention patients.
Why the study?
The study was conducted to evaluate pooled survival and complication rates of Impella heart pumps used in cardiogenic shock and high-risk PCI.
Does Impella mechanical circulatory support improve survival and maintain low complication rates in patients with cardiogenic shock or undergoing high-risk PCI?
Study Design
Type
Meta-Analysis (n=2,827)
Multicenter
Yes
Structured PICO
Does Impella mechanical circulatory support improve survival and maintain low complication rates in patients with cardiogenic shock or undergoing high-risk PCI?
P
Population
2,827 patients from 33 studies (40.5% cardiogenic shock [n=1,144], 59.5% high-risk PCI [n=1,715]), mean age 64.9, 74.6% male.
I
Intervention
Impella heart pumps (Impella 2.5, Impella CP, Impella 5.0, Impella LD) for mechanical circulatory support
O
Outcome
Pooled survival (to next therapy, discharge, 30-days, 90-days, 6 months, 1 year) and complications (stroke/TIA, MI, revascularization, MACE, bleeding, hemolysis, renal dysfunction, limb ischemia, device malfunction)hard clinical
Impella devices demonstrate encouraging survival rates and acceptable safety profiles in both cardiogenic shock and high-risk PCI, though evidence is largely driven by observational data.
Limitations
- Not a comparative analysis, limiting inferences about exact benefit relative to other left ventricular support devices.
- A large proportion of eligible studies included in the meta-analyses were low-quality case series.
- Unacceptably high levels of heterogeneity for several key outcomes.
- Unacceptably high heterogeneity for some survival outcomes
- Absence of sufficiently powered randomized clinical trials
- Reliance on observational and retrospective studies
Authors
Discussion
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Implication
Supports Impella consideration in cardiogenic shock and high-risk PCI; leaves open randomized confirmation of benefit.
Cite This Study
Hill et al. (2019) conducted a meta-analysis in Cardiogenic shock and high-risk percutaneous coronary intervention (HRPCI) (n=2,827). Impella devices was evaluated on Survival at 90 days (Cardiogenic shock, retrospective studies) (95% CI 53.9%-70.9%). Impella devices demonstrated a pooled 90-day survival rate of 62.6% in cardiogenic shock and a 30-day survival rate of 92.2% in high-risk percutaneous coronary intervention patients.
Topics
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