Efficacy and safety of microaxial flow pump in infarct-related cardiogenic shock: a meta-analysis.

Introduction: Data regarding mechanical circulatory support with a microaxial flow pump (Impella) in patients with myocardial infarction complicated by cardiogenic shock are limited. Methods: PubMed/Medline, Embase, and the Cochrane Library were used to search for randomized controlled trials (RCTs) from inception to 16 June 2024. Risk ratios (RRs) were pooled with corresponding 95% confidence intervals (CIs) using the random effects model. Results: Four RCTs were included. The pooled analysis demonstrated a significantly reduced risk of all-cause death in patients with the use of a microaxial flow pump at 6-month follow-up (RR = 0.80; 95% CI: 0.67 to 0.97) and cardiac death (RR = 0.68; 95% CI: 0.49 to 0.94) as compared to the control group. However, the use of a microaxial flow pump was associated with a significantly increased risk of major bleeding (RR = 2.27; 95% CI: 1.21 to 4.24), limb ischemia (RR = 4.46; 95% CI: 1.31 to 15.16), and sepsis (RR = 2.01; 95% CI: 1.11 to 3.67). The risk of stroke and rehospitalizations remained comparable across the two groups. Conclusions: The use of a microaxial flow pump in infarct-related cardiogenic shock can reduce mortality at the expense of increased risk of bleeding, limb ischemia, and sepsis. Further research is required to validate our findings.