Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trials
Objective The survival benefit of using mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) is still controversial. It is necessary to explore the impact on clinical outcomes of MCS in patients with AMI undergoing stenting.Design Systematic review and meta-analysi...
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BMJ Publishing Group
2021-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/6/e044072.full |
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| author | Yao Lu Jingjing Cai Weihong Jiang Hong Yuan Yan Tang Yujie Wang Yunmin Shi Xuejing Sun Mengqing Jiang Yuanyuan Bai Suzhen Liu |
| author_facet | Yao Lu Jingjing Cai Weihong Jiang Hong Yuan Yan Tang Yujie Wang Yunmin Shi Xuejing Sun Mengqing Jiang Yuanyuan Bai Suzhen Liu |
| author_sort | Yao Lu |
| collection | DOAJ |
| description | Objective The survival benefit of using mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) is still controversial. It is necessary to explore the impact on clinical outcomes of MCS in patients with AMI undergoing stenting.Design Systematic review and meta-analysis.Data sources Embase, Cochrane Library, Medline, PubMed, Web of Science, ClinicalTrials.gov and Clinicaltrialsregister.eu databases were searched from database inception to February 2021.Eligibility criteria Randomised clinical trials (RCTs) on MCS use in patients with AMI undergoing stent implantation were included.Data extraction and synthesis Data were extracted and summarised independently by two reviewers. Risk ratios (RRs) and 95% CIs were calculated for clinical outcomes according to random-effects model.Results Twelve studies of 1497 patients with AMI were included, nine studies including 1382 patients compared MCS with non-MCS, and three studies including 115 patients compared percutaneous ventricular assist devices (pVADs) versus intra-aortic balloon pump (IABP). Compared with non-MCS, MCS was not associated with short-term (within 30 days) (RR=0.90; 95% CI 0.57 to 1.41; I2=46.8%) and long-term (at least 6 months) (RR=0.82; 95% CI 0.57 to 1.17; I2=37.6%) mortality reductions. In the subset of patients without cardiogenic shock (CS) compared with non-MCS, the patients with IABP treatment significantly had decreased long-term mortality (RR=0.49; 95% CI 0.27 to 0.90; I2=0), but without the short-term mortality reductions (RR=0.51; 95% CI 0.22 to 1.19; I2=17.9%). While in the patients with CS, the patients with MCS did not benefit from the short-term (RR=1.09; 95% CI 0.67 to 1.79; I2=46.6%) or long-term (RR=1.00; 95% CI 0.75 to 1.33; I2=22.1%) survival. Moreover, the application of pVADs increased risk of bleeding (RR=1.86; 95% CI 1.15 to 3.00; I2=15.3%) compared with IABP treatment (RR=1.86; 95% CI 1.15 to 3.00; I2=15.3%).Conclusions In all patients with AMI undergoing stent implantation, the MCS use does not reduce all-cause mortality. Patients without CS can benefit from MCS regarding long-term survival, while patients with CS seem not. |
| format | Article |
| id | doaj-art-8305e8ea60544da09fba940b8c704d3a |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-06-01 |
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| series | BMJ Open |
| spelling | doaj-art-8305e8ea60544da09fba940b8c704d3a2024-11-20T01:40:08ZengBMJ Publishing GroupBMJ Open2044-60552021-06-0111610.1136/bmjopen-2020-044072Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trialsYao Lu0Jingjing Cai1Weihong Jiang2Hong Yuan3Yan Tang4Yujie Wang5Yunmin Shi6Xuejing Sun7Mengqing Jiang8Yuanyuan Bai9Suzhen Liu101 Peking University Clinical Research Institute, Peking University First Hospital, Beijing, ChinaCentral South University Third Xiangya Hospital, Changsha City, ChinaDepartment of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaClinical Research Center, Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Biotherapy, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China1 Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Eye Diseases; Key Laboratory of Ocular Fundus Diseases; Engineering Center for Visual Science and Photomedicine; Engineering Center for Precise Diagnosis and Treatment of Eye Diseases, Shanghai, ChinaDepartment of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Cardiology, Third Xiangya Hospital, Central South University, Changsha, Hunan, ChinaObjective The survival benefit of using mechanical circulatory support (MCS) in patients with acute myocardial infarction (AMI) is still controversial. It is necessary to explore the impact on clinical outcomes of MCS in patients with AMI undergoing stenting.Design Systematic review and meta-analysis.Data sources Embase, Cochrane Library, Medline, PubMed, Web of Science, ClinicalTrials.gov and Clinicaltrialsregister.eu databases were searched from database inception to February 2021.Eligibility criteria Randomised clinical trials (RCTs) on MCS use in patients with AMI undergoing stent implantation were included.Data extraction and synthesis Data were extracted and summarised independently by two reviewers. Risk ratios (RRs) and 95% CIs were calculated for clinical outcomes according to random-effects model.Results Twelve studies of 1497 patients with AMI were included, nine studies including 1382 patients compared MCS with non-MCS, and three studies including 115 patients compared percutaneous ventricular assist devices (pVADs) versus intra-aortic balloon pump (IABP). Compared with non-MCS, MCS was not associated with short-term (within 30 days) (RR=0.90; 95% CI 0.57 to 1.41; I2=46.8%) and long-term (at least 6 months) (RR=0.82; 95% CI 0.57 to 1.17; I2=37.6%) mortality reductions. In the subset of patients without cardiogenic shock (CS) compared with non-MCS, the patients with IABP treatment significantly had decreased long-term mortality (RR=0.49; 95% CI 0.27 to 0.90; I2=0), but without the short-term mortality reductions (RR=0.51; 95% CI 0.22 to 1.19; I2=17.9%). While in the patients with CS, the patients with MCS did not benefit from the short-term (RR=1.09; 95% CI 0.67 to 1.79; I2=46.6%) or long-term (RR=1.00; 95% CI 0.75 to 1.33; I2=22.1%) survival. Moreover, the application of pVADs increased risk of bleeding (RR=1.86; 95% CI 1.15 to 3.00; I2=15.3%) compared with IABP treatment (RR=1.86; 95% CI 1.15 to 3.00; I2=15.3%).Conclusions In all patients with AMI undergoing stent implantation, the MCS use does not reduce all-cause mortality. Patients without CS can benefit from MCS regarding long-term survival, while patients with CS seem not.https://bmjopen.bmj.com/content/11/6/e044072.full |
| spellingShingle | Yao Lu Jingjing Cai Weihong Jiang Hong Yuan Yan Tang Yujie Wang Yunmin Shi Xuejing Sun Mengqing Jiang Yuanyuan Bai Suzhen Liu Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trials BMJ Open |
| title | Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trials |
| title_full | Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trials |
| title_fullStr | Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trials |
| title_full_unstemmed | Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trials |
| title_short | Effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation: a systematic review and meta-analysis of randomised controlled trials |
| title_sort | effects of mechanical circulatory support devices in patients with acute myocardial infarction undergoing stent implantation a systematic review and meta analysis of randomised controlled trials |
| url | https://bmjopen.bmj.com/content/11/6/e044072.full |
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