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

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Abstract

Background

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.

Objectives

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.

Methods

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.

Results

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).

Conclusions

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)

Key Words

acute myocardial infarction
cardiogenic shock
intra-aortic balloon pump
mechanical circulatory support
randomized controlled trial

Abbreviations and Acronyms

AMI
acute myocardial infarction
CS
cardiogenic shock
IABP
intra-aortic balloon pump
LVAD
left ventricular assist device
PCI
percutaneous cardiac intervention
pMCS
percutaneous mechanical circulatory support
ROSC
return of spontaneous circulation

Cited by (0)

The trial was funded by the Academic Medical Center, Amsterdam. The Academic Medical Center has received research grants and speaker honoraria from Abiomed Inc. Dr. Piek has served on the medical advisory board of Abbott Vascular; and has served as a consultant for Philips Volcano. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.