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

详细信息    查看全文

• 作者：Dagmar M. Ouweneel ; MSc^a ; Erlend Eriksen ; MD^b ; Krischan D. Sjauw ; MD ; PhD^a ; Ivo M. van Dongen ; MD^a ; Alexander Hirsch ; MD ; PhD^a ; Erik J.S. Packer ; MD^b ; M. Marije Vis ; MD ; PhD^a ; Joanna J. Wykrzykowska ; MD ; PhD^a ; Karel T. Koch ; MD ; PhD^a ; Jan Baan ; MD ; PhD^a ; Robbert J. de Winter ; MD ; PhD^a ; Jan J. Piek ; MD ; PhD^a ; Wim K. Lagrand ; MD ; PhD^c ; Bas A.J.M. de Mol ; MD ; PhD^a ; Jan G.P. Tijssen ; PhD^a ; José ; P.S. Henriques ; MD ; PhD^a ; ^{j.p.henriques@amc.uva.nl}
• 关键词：acute myocardial infarction ; cardiogenic shock ; intra-aortic balloon pump ; mechanical circulatory support ; randomized controlled trial
• 刊名：Journal of the American College of Cardiology
• 出版年：2017
• 出版时间：24 January 2017
• 年：2017
• 卷：69
• 期：3
• 页码：278-287
• 全文大小：961 K
• 卷排序：69

文摘

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.ObjectivesThe 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.MethodsIn 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.ResultsAt 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).ConclusionsIn 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)