Acute cardiac care & resuscitationMeta-analysis
Temporary mechanical circulatory support in infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials with 6-month follow-up
- Individual patient data meta-analysis of randomised trials
Authors' conclusion
The use of active MCS devices in patients with AMICS did not reduce 6-month mortality (regardless of the device used) and increased major bleeding and vascular complications.
Study context
- Population
- Patients with acute MI-related cardiogenic shock (AMICS)9 RCT reports
- Participants
- 1,114 patients
- Comparison
- Early routine active percutaneous mechanical circulatory support (MCS) vs control
- Outcome
- All-cause mortality
- Follow-up
- 6 months
Pooled result
As reported in the abstract
Hazard ratio
0.87
95% CI 0.74–1.03
P = 0.10
MCS vs Control
HR 0.87 (95% CI 0.74–1.03); P = 0.10
Further pooled results
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| 6-month mortality, by device type (subgroup) · 6 months — MCS vs Control · LV unloading devices (5 RCTs, n=503) | 0.80 (0.62–1.02) | P = 0.075 | |
| 6-month mortality, by device type (subgroup) · 6 months — MCS vs Control · loading devices (VA-ECMO; 4 RCTs, n=611) | 0.93 (0.75–1.17) | P = 0.55 | |
| 6-month mortality, ST-elevation cardiogenic shock without risk of hypoxic brain injury (subgroup) | 0.77 (0.61–0.97) | P = 0.024 | |
| 0.512Hazard ratio (log scale) |
Safety
| Outcome | OR (95% CI) | |
|---|---|---|
| Major bleeding | 2.64 (1.91–3.65) | |
| Vascular complications | 4.43 (2.37–8.26) | |
| 0.10.31310Odds ratio (log scale) |
Original publication
Temporary mechanical circulatory support in infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials with 6-month follow-up. Lancet. Published 2 September 2024. doi:10.1016/s0140-6736(24)01448-x
Summarised from the published abstract; every number is checked against it