D-18 | Impella in Myocardial Infarction Complicated by Cardiogenic Shock: A Meta-Analysis

Despite technological advancement, mortality remains high when myocardial infarction is complicated by cardiogenic shock. Impella has been advocated as an adjunct to the standard of care but conflicting data has hindered greater utilization. We inform initial impressions of the technology with an updated meta-analysis. We searched PubMed and Embase, screened 787 articles, and identified eleven studies that met eligibility criteria; these randomized controlled trials and cohort studies compared Impella to other mechanical circulatory support systems in patients with myocardial infarction complicated by cardiogenic shock. We evaluated groups with twenty-three metrics related to adverse events and clinical outcomes. A random effects model assessed heterogeneity between studies. We did not find a statistically significant difference between groups across all twenty-three included metrics: 30-day mortality, 6-month mortality, in-house mortality, brain death, cardiovascular death, non-cardiac mortality, successful wean, myocardial infarction, need for repeat percutaneous coronary intervention, coronary bypass artery graft, revascularization, transplant, stroke, technical failures, gastrointestinal bleeding, limb ischemia, hemolysis, major bleeding, sepsis, and thrombosis and acute kidney injury. Our meta-analysis did not relate Impella use to better outcomes. Heterogeneity in timing of device implantation calls for stricter reporting in subsequent larger, randomized controlled trials.