Comparative Effectiveness of Mechanical Circulatory Support Devices in Patients Undergoing Complex High‐Risk Percutaneous Coronary Interventions (CHIP): A Systematic Review and Network Meta‐Analysis
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Le résumé fourni par la source
BACKGROUND: Patients undergoing complex high-risk percutaneous coronary interventions (CHIP) are prone to hemodynamic instability, and the optimal mechanical circulatory support (MCS) strategy for this population remains unclear. AIMS: This systematic review and network meta-analysis aimed to compare the short-term safety and efficacy of various MCS strategies in CHIP. METHODS: We systematically searched PubMed, Web of Science, Embase, and the Cochrane Library for studies comparing different MCS strategies in CHIP patients with short-term endpoints. The primary efficacy outcome was in-hospital or 30-day mortality. Safety outcomes included MCS-related complications, specifically bleeding and stroke. The MCS strategies evaluated were intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (VA-ECMO), IMPELLA, VA-ECMO + IABP, and VA-ECMO + IMPELLA (ECPELLA). A random-effects Bayesian network meta-analysis was performed, integrating both direct and indirect comparisons. RESULTS: Twelve studies involving a total of 75,274 patients were included. Both IABP (OR: 0.33; 95% CI: 0.13-0.91) and IMPELLA (OR: 0.44; 95% CI: 0.21-0.96) were associated with significantly lower short-term mortality compared to VA-ECMO. No significant differences were observed among other strategies. Rank probability analysis suggested that IABP had the highest probability of being the most effective strategy for reducing short-term mortality. Regarding safety outcomes, IABP was associated with a significantly lower bleeding risk compared to VA-ECMO (OR: 0.18; 95% CI: 0.04-0.82), VA-ECMO + IABP (OR: 0.18; 95% CI: 0.03-0.87), ECPELLA (OR: 0.12; 95% CI: 0.02-0.70), and IMPELLA (OR: 0.21; 95% CI: 0.05-0.75), with no significant difference in stroke risk across strategies. CONCLUSIONS: Among available MCS strategies for CHIP patients, IABP appears to be associated with improved short-term survival and a lower risk of bleeding, without an increased risk of stroke. These findings support IABP as a potentially preferable support option, warranting further validation in prospective clinical trials.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Comparative Effectiveness of Mechanical Circulatory Support Devices in Patients Undergoing Complex High‐Risk Percutaneous Coronary Interventions (CHIP): A Systematic Review and Network Meta‐Analysis
- Date Crossref
- 09/06/2025
- Éditeur
- Wiley
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
Où se fait cette recherche
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Second Hospital of Tianjin Medical University Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease pays non établi dans la noticeÉtablissement de santé
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Tianjin Medical University pays non établi dans la noticeUniversité ou école supérieure
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Chinese University of Hong Kong pays non établi dans la noticeUniversité ou école supérieure
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PowerELab (China) pays non établi dans la noticeEntreprise
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University of Hong Kong pays non établi dans la noticeUniversité ou école supérieure
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School of Clinical Medicine Department of Medicine pays non établi dans la noticeUniversité ou école supérieure
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Diabetes Research Unit Cardiovascular Analytics Group pays non établi dans la noticeStructure de recherche
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School of Nursing and Health Studies Hong Kong Metropolitan University Hong Kong China pays non établi dans la noticeUniversité ou école supérieure
Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular Disease — Second Hospital of Tianjin Medical University, Tianjin Medical University et Chinese University of Hong Kong, avec 5 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.