Table 2.
Summary of major studies of temporary mechanical support in cardiogenic shock
| Major studies of device intervention and outcome in cardiogenic shock | ||||||
|---|---|---|---|---|---|---|
| Study | Year | Interventions and objective | Design | n | Etiology | Findings |
| IABP | ||||||
| Thiele et al. (IABP-SHOCK II) [37] | 2012 | PCI with IABP vs. without in AMI-CS | Multicenter RCT | 600 | AMI-CS | Routine use of IABP did not reduce mortality at 30 days (RR 0.96, 95% CI 0.79–1.17) |
| Sjauw et al. [38] | 2008 | ST-elevation myocardial infarction outcomes with/ without CS treated with/without IABP | Meta-analysis of RCTs compared to cohort studies | 11,538; 10,529 with CS | AMI-CS | Among RCTs, IABP was not associated with mortality at 30 days (OR 0.01, 95% CI − 0.03 to 0.04; I2 = 0%). Among cohort studies, IABP was associated with improved 30-day mortality (OR − 0.11, 95% CI − 0.13 to − 0.19; I2 = 93.6%) |
| Unverzagt et al. [40] | 2011 | AMI-CS outcomes with IABP vs. other or no cardiac assist devices | Meta-analysis, RCTs | 190 | AMI-CS | IABP was not associated with improvement in 30-day mortality (HR 1.04, 95% CI 0.62–1.73) |
| Bahekar et al. [39] | 2012 | AMI outcomes with or without CS treated with or without IABP | Meta-analysis, RCTs and cohort studies | 11,778; 5272 with CS | AMI-CS | IABP was associated with improved inpatient mortality (RR 0.72, 95% CI 0.60–0.86; I2 = 58.9%) |
| TandemHeart | ||||||
| Thiele et al. [41] | 2001 | Hemodynamics after placement among patients with AMI-CS | Case series | 18 | AMI-CS | Cardiac index improved by 41% on average with concomitant reduction in PCWP, CVP, and pulmonary artery pressure |
| Burkhoff et al. [43] | 2006 | Comparison of CS outcomes with IABP vs. TandemHeart | Multicenter RCT | 42 | Any; 70% with AMI-CS | TandemHeart improved cardiac index by 0.5 compared to only 0.2 for IABP (p < 0.05). 30-day mortality was 36% in the IABP cohort vs. 47% for TandemHeart (p > 0.05) |
| Kar et al. [44] | 2011 | Outcomes in ischemic vs. non-ischemic patients | Single-center retrospective cohort | 117 | Any; 4% with AMI | Improved survival with non-ischemic vs. ischemic CS (0.6 vs. 0.4 in Kaplan–Meier analysis, up to 1400 days (p < 0.05) |
| Ni hIci et al. [48] | 2020 | Impella or TandemHeart vs. IABP | Meta-analysis, RCTs | 162 | Any | No difference in 30-day mortality with Impella or TandemHeart individually compared to IABP (RR 1.01, 95% CI 0.76–1.35) |
| IMPELLA | ||||||
| O’Neill et al. [49] | 2014 | AMI-CS outcomes of Impella 2.5 pre- vs. post-PCI | Retrospective database review | 154 | AMI-CS | Pre-PCI patients had more complete revascularization and better survival to discharge (65.1% vs. 40.7%, p = 0.003) |
| Miyashita et al. [50] | 2021 | Comparison of AMI-CS pre- vs. post-PCI | Meta-analysis, cohort studies | 432 | AMI-CS | Improved mortality acutely (RR 0.62, 95% CI 0.50–0.76), and at 6 months (HR 0.66, 95% CI 0.44–0.97; I2 = 0% for all) Pre-PCI patients |
| Iannaccone et al. [51] | 2020 | Evaluation of CS outcomes following Impella implant; no comparator group | Meta-analysis, cohort studies | 2210 | Any; 75.9% with AMI | With placement of an Impella, 30-day mortality was 47.8% |
| Chung et al. [52] | 2020 | Evaluation of CS outcomes (recovery, LVAD, or transplant) Impella 5.0; no comparator group | Single-center retrospective cohort | 100 | Any | Overall survival 64%, 50% for patients without definitive advanced heart failure therapy, 48% for patients who underwent durable LVAD, and 81% for patients who underwent transplant |