Aims:

The use of intra-aortic balloon pumps (IABP) or percutaneous left ventricular assist devices (pLVAD) in patients with cardiogenic shock (CS) or high-risk percutaneous coronary interventions (PCI) is controversial due to limited data. This study aims to investigate the impact of these devices on hemodynamic and clinical outcomes in patients with high-risk PCI or CS.

Methods:

We systematically searched Embase, PubMed, and Scopus for randomized controlled trials (RCTs) and observational studies comparing pLVAD versus IABP or medical therapy in high-risk PCI or CS patients. The primary outcome was major adverse cardiovascular events (MACE). Secondary endpoints included in-hospital stroke and severe bleeding etc. Heterogeneity was assessed using I2 statistics, and a random-effects model was applied for outcomes with low and high heterogeneity.

Results:

This meta-analysis of 7 RCTs and 27 observational studies including 73,701 patients that compared pLVAD to IABP or medical therapy in high-risk PCI or CS patients over a follow-up of 1 month to 1 year. The mean age was 62.4 ± 13.2 years and 34.6 % of the patients were female. There was no significant difference between both groups for in-hospital or 30-day all-cause mortality (OR 1.15; 95% CI 0.90, 1.44; p = 0.268), MACE (OR 0.97; 95% CI 0.66, 1.43; P = 0.896), stroke in-hospital (OR 1.21; 95% CI 0.95, 1.54; p = 0.116). The incidence of kidney replacement therapy (KRT) (OR 1.73; 95% CI 1.46, 2.05; p < 0.001), life-threatening bleeding (OR 2.37; 95% CI 1.84, 3.04; p < 0.001), peripheral vascular access complications (OR 2.09; 95% CI 1.12, 3.88; p = 0.020), acute kidney injury (AKI) (OR 1.50; 95% CI 1.39, 1.61; p < 0.001) and hemolytic anemia (OR 6.17; 95% CI 2.00, 19.01; p = 0.002) were significantly lowered in the pLVAD group than in the IABP or medical therapy group. Conversely, pLVAD significantly improved mean arterial pressure (MAP) (MD 11.87; 95% CI 6.72, 17.01; p < 0.01) and cardiac index (MD 0.36; 95% CI 0.14, 0.57; p < 0.01) . Furthermore, the use of pLVAD was associated with increased pulmonary capillary wedge pressure (PCWP) (MD -5.57; 95% CI -10.14, -1.04; p = 0.02).

Conclusion:

Our meta-analysis found no differences between pLVAD and IABP or medical therapy in in-hospital or 30-day, MACE and stroke in patients with high-risk PCI or CS. However, the use of pLVAD improved cardiac index, MAP as well as reduced the incidence of life-threatening bleeding. Adequately powered randomized controlled trials comparing pLVAD with IABP or medical therapy in patients with high-risk PCI or CS are warranted to define the optimal treatment strategy in patients with high-risk cohort.