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


OBJECTIVE
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).
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Dagmar M
DM
Ouweneel
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Erlend
E
Eriksen
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Krischan D
KD
Sjauw
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Ivo M
IM
van Dongen
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Alexander
A
Hirsch
Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
Erik J S
EJ
Packer
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
M Marije
MM
Vis
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Joanna J
JJ
Wykrzykowska
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Karel T
KT
Koch
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Jan
J
Baan
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Robbert J
RJ
de Winter
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Jan J
JJ
Piek
Department of Intensive Care Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Wim K
WK
Lagrand
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Bas A J M
BA
de Mol
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands.
Jan G P
JG
Tijssen
AMC Heart Center, Academic Medical Center-University of Amsterdam, Amsterdam, the Netherlands. Electronic address: j.p.henriques@amc.uva.nl.
José P S
JP
Henriques
D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
acute myocardial infarction; cardiogenic shock; intra-aortic balloon pump; mechanical circulatory support; randomized controlled trial