Key result
Routine LV unloading plus PCI fails to reduce all-cause mortality in STEMI without shock.
Why the study?
Current guidelines support left ventricular unloading in STEMI complicated by cardiogenic shock, but the clinical benefits of routine left ventricular unloading during PCI in STEMI without cardiogenic shock remain uncertain.
Does percutaneous left ventricular unloading added to percutaneous coronary intervention improve all-cause mortality, infarct size, major bleeding, and TIMI-3 flow in patients with ST-elevation myocardial infarction without cardiogenic shock?
Meta-Analysis (n=1,501)
Randomized controlled trials
Does percutaneous left ventricular unloading added to percutaneous coronary intervention improve all-cause mortality, infarct size, major bleeding, and TIMI-3 flow in patients with ST-elevation myocardial infarction without cardiogenic shock?
Routine percutaneous left ventricular unloading during PCI in STEMI patients without cardiogenic shock does not significantly improve all-cause mortality, infarct size, or TIMI-3 flow, and shows a nonsignificant trend toward increased major bleeding.
Answers are grounded in this paper and cite their sources.
No mortality benefit with LV unloading plus PCI in non-shock STEMI; challenges extension of shock-trial benefits to this population.
Background: Current guidelines support the use of left ventricular unloading (LVU) in ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS); however the clinical benefits of routine LV unloading during percutaneous intervention (PCI) in STEMI remains uncertain. Objectives: We aim to evaluate clinical outcomes of percutaneous LV unloading in addition to PCI compared with PCI alone in patients with STEMI without cardiogenic shock. Methods: We searched PUBMED, Embase and Cochrane for studies comparing LVU plus PCI versus PCI alone in STEMI patients without CS. The main outcomes were all-cause mortality (ACM), infarct size, major bleeding and TIMI-3 flow. Statistical analysis was performed using R software 4.5.1. Heterogeneity was assessed using I2 statistics. Results: We included 1501 patients from 5 RCTs. 736 (49.0%) patients were treated with LVU plus PCI. There was no significant difference in ACM (RR 0.79; 95% CI 0.46-1.37; p = 0.345; I 2 = 0%), TIMI-3 flow (RR 1.02; 95% CI 0.97-1.08; p = 0.407; I2 = 40.9%) or Infarct size (as percentage of LV mass) between the two groups (MD 1.34; 95% CI -4.19 to 6.87; p = 0.066; I 2 = 70.4%). LVU showed nonsignificant trend toward increase in major bleeding in the LVU group (RR 2.68; 95% CI 0.96-7.47; p = 0.0597; I 2 =88.0%;). Conclusion: In this RCT-only meta-analysis, LVU with PCI in STEMI was not associated with significant improvements in mortality, TIMI-3 flow, or infarct size. However, LVU demonstrated a nonsignificant trend toward increased major bleeding.
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Mukhtar et al. (2026) conducted a meta-analysis in ST-elevation myocardial infarction without cardiogenic shock (n=1,501). Left ventricular unloading plus percutaneous coronary intervention vs. Percutaneous coronary intervention alone was evaluated on All-cause mortality (RR 0.79, 95% CI 0.46-1.37, p=0.345). Left ventricular unloading plus PCI did not reduce all-cause mortality compared with PCI alone in STEMI without cardiogenic shock.
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