COMPARATIVE SAFETY OF PERCUTANEOUS VENTRICULAR ASSIST DEVICE AND INTRA-AORTIC BALLOON PUMP IN ACUTE MYOCARDIAL INFARCTION INDUCED CARDIOGENIC SHOCK.
Presenter
Mohamed Zghouzi, MD, The University of Michigan, Dearborn Heights, MI
Mohamed Zghouzi, MD1, Waqas Ullah, M.D.2, Ali Banisad, MD3, Ghaith Alhatemi, MD3, Yasar Sattar, MD4, Nathan Zaher, MD3, Abdul-Rahman M. Suleiman3, Bachar Ahmad3, Salman Zahid5, Homam Moussa Pacha, M.D6, Zaher Hakim, M.D.7 and M Chadi Alraies, MD, FSCAI8, (1)The University of Michigan, Dearborn Heights, MI, (2)Abington Jefferson Health, Abington, PA, (3)Detroit Medical Center Heart Hospital, Detroit, MI, (4)Icahn School of Medicine at Mount Sinai Elmhurst, Elmhurst, NY, (5)Rochester General Hospital, Rochester, NY, (6)MedStar Washington Hospital Center, Washington, DC, (7)Harper University Hospital, Northville, MI, (8)Detroit Medical Center Heart Hospital, Bloomfield , MI
Keywords: Acute Coronary Syndromes (ACS), Cardiogenic shock, Coronary and Hemodynamic support
Background
The relative safety of percutaneous left ventricular assist device (pVAD) and intra-aortic balloon pump (IABP) in acute myocardial infarction with cardiogenic shock (CS) remains unknown. Methods
Digital databases were searched to identify articles comparing pVAD and IABP. An unadjusted odds ratio was used to calculate hard clinical outcomes and mortality differences on a random effect model. Results
Seven studies comprising 26,726 patients (1110 pVAD vs. 25,616 IABP) were included. The odds of all-cause mortality (OR 0.57, 95% CI 0.47-0.68, p=<0.00001) (Figure 1), and need for revascularization (OR 0.16, 95% CI, 0.07-0.38, p=<0.0001) were significantly reduced in patients receiving pVAD compared to IABP. The odds of stroke (OR 1.12, 95% CI, 0.14-9.17, p= 0.91), acute limb ischemia (OR= 2.48, 95% CI, 0.39-15.66, p= 0.33) and major bleeding (OR 0.36, 95% CI, 0.01-25.39, p= 0.64) were not significantly different between the two groups. A sensitivity analysis based on exclusion of the study with the largest weight showed no difference in the mortality difference between the two mechanical circulatory support (MCS) devices. Conclusions
In patients with acute MI complicated by CS there, pVAD was associated with lower all-cause mortality and similar major bleeding, stroke and limb ischemia compared with IABP. 