Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction

• Published in: Journal of the American College of Cardiology Vol. 69; no. 3; pp. 278 - 287
• Main Authors: Ouweneel, Dagmar M., Eriksen, Erlend, Sjauw, Krischan D., van Dongen, Ivo M., Hirsch, Alexander, Packer, Erik J.S., Vis, M. Marije, Wykrzykowska, Joanna J., Koch, Karel T., Baan, Jan, de Winter, Robbert J., Piek, Jan J., Lagrand, Wim K., de Mol, Bas A.J.M., Tijssen, Jan G.P., Henriques, José P.S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 24.01.2017; Elsevier Limited
• Subjects: acute myocardial infarction; cardiogenic shock; Cardiology; Clinical outcomes; Coronary vessels; Ethics; Female; Heart attacks; Heart surgery; Heart-Assist Devices; Humans; Informed consent; intra-aortic balloon pump; Intra-Aortic Balloon Pumping; Male; mechanical circulatory support; Middle Aged; Mortality; Myocardial Infarction - complications; Prospective Studies; randomized controlled trial; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; Statistical analysis; Stroke; Treatment Outcome; CS; intra-aortic balloon pump; IABP; PCI; mechanical circulatory support; pMCS; cardiogenic shock; ROSC; AMI; acute myocardial infarction; LVAD; randomized controlled trial
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2016.10.022

Despite advances in treatment, mortality in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains high. Short-term mechanical circulatory support devices acutely improve hemodynamic conditions. The aim of this study was to determine whether a new percutaneous mechanical circulatory support (pMCS) device (Impella CP, Abiomed, Danvers, Massachusetts) decreases 30-day mortality when compared with an intra-aortic balloon pump (IABP) in patients with severe shock complicating AMI. In a randomized, prospective, open-label, multicenter trial, 48 patients with severe CS complicating AMI were assigned to pMCS (n = 24) or IABP (n = 24). Severe CS was defined as systolic blood pressure <90 mm Hg or the need for inotropic or vasoactive medication and the requirement for mechanical ventilation. The primary endpoint was 30-day all-cause mortality. At 30 days, mortality in patients treated with either IABP or pMCS was similar (50% and 46%, respectively; hazard ratio with pMCS: 0.96; 95% confidence interval: 0.42 to 2.18; p = 0.92). At 6 months, mortality rates for both pMCS and IABP were 50% (hazard ratio: 1.04; 95% confidence interval: 0.47 to 2.32; p = 0.923). In this explorative randomized controlled trial involving mechanically ventilated patients with CS after AMI, routine treatment with pMCS was not associated with reduced 30-day mortality compared with IABP. (IMPRESS in Severe Shock; NTR3450) [Display omitted]