Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock
Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock
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DOI：
10.1136/openhrt-2018-000987
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发表时间：
2019-01-01
期刊：
影响因子：
2.7
通讯作者：
Skurk, Carsten
中科院分区：
文献类型：
--
作者：
Alushi, Brunilda;Douedari, Andel;Skurk, Carsten
目的比较现代经皮机械支持(PMCs)装置Impella与传统标准主动脉内球囊反搏(IABP)治疗急性心肌梗死合并心源性休克(AMICS)的疗效。用IABP-休克II评分评估基线时的疾病严重程度。主要结果是30天内全死因死亡。次要结果是移植后早期休克严重程度的参数。结果116例患者中，62例(53%)接受Impella治疗，54例(47%)接受IABP。尽管基线死亡风险相似(IABP-休克II高危评分为18%比20%；p=0.76)，Impella显著降低了肌力评分(p<；0.001)、乳酸水平(p<；0.001)和SAPS II(p=0.02)，并改善了左心室射血分数(p=0.01)。30天的全因死亡率与Impella和IABP相似(分别为52%和67%；p=0.13)，但Impella组更容易出现出血并发症(因出血并发症而输注浓缩红细胞3单位比4单位，p=0.03)。既往心肺复苏史(HR 3.22，95%CI 1.76至5.89；P<；0.01)和估计的中级(HR 2.77，95%CI 1.42至5.40；P<；0.01)和高(HR 4.32 95%CI 2.03至9.24；P=0.01)IABP-休克II评分是全因死亡的独立预测因素。在这些患者中，有必要进行大型随机试验，以确定Impella对结果的影响。
Objective We investigated the benefit of Impella, a modern percutaneous mechanical support (pMCS) device, versus former standard intra-aortic balloon pump (IABP) in acute myocardial infarction complicated by cardiogenic shock (AMICS).Methods This single-centre, retrospective study included patients with AMICS receiving pMCS with either Impella or IABP. Disease severity at baseline was assessed with the IABP-SHOCK II score. The primary outcome was allcause mortality at 30 days. Secondary outcomes were parameters of shock severity at the early postimplantation phase. Adjusted Cox proportional hazards models identified independent predictors of the primary outcome.Results Of 116 included patients, 62 (53%) received Impella and 54 (47%) IABP. Despite similar baseline mortality risk (IABP-SHOCK II high-risk score of 18 % vs 20 %; p = 0.76), Impella significantly reduced the inotropic score (p < 0.001), lactate levels (p < 0.001) and SAPS II (p = 0.02) and improved left ventricular ejection fraction (p = 0.01). All-cause mortality at 30 days was similar with Impella and IABP (52 % and 67 %, respectively; p = 0.13), but bleeding complications were more frequent in the Impella group (3 vs 4 units of transfused erythrocytes concentrates due to bleeding complications, p = 0.03). Previous cardiopulmonary resuscitation (HR 3.22, 95% CI 1.76 to 5.89; p < 0.01) and an estimated intermediate (HR 2.77, 95% CI 1.42 to 5.40; p < 0.01) and high (HR 4.32 95% CI 2.03 to 9.24; p = 0.01) IABP-SHOCK II score were independent predictors of all-cause mortality.Conclusions In patients with AMICS, haemodynamic support with the Impella device had no significant effect on 30-day mortality as compared with IABP. In these patients, large randomised trials are warranted to ascertain the effect of Impella on the outcome.