Comparative efficacy and safety of mechanical circulatory support in ST-elevation myocardial infarction with cardiogenic shock: a network meta-analysis
- 1Department of Cardiology, The First Affiliated Hospital of Dalian Medical University
Abstract
Background: ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock carries high mortality, yet optimal treatment remains uncertain in this distinct patient population. The aim of this study is to systematically evaluate and compare the efficacy of mechanical circulatory support (MCS) devices, vasoactive agents, and inotropic agents in the management of critical adult patients with STEMI complicating cardiogenic shock.
Methods: A network meta-analysis (PROSPERO CRD420251002524) was conducted, with systematic searches of six databases (Embase, Web of Science, PubMed, and Cochrane, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform) from inception to March 2025 for randomized and observational studies. We also updated the search to September 2026 using the same search strategy.
Results: Data from 22 studies (pooled n = 360,235) revealed a predominantly male (65%), older adult population (mean age 67 years), US-based (97.9%) population with hypertension, hyperlipidemia, diabetes or heart failure. Compared with intra-aortic balloon pump (IABP), based on observational evidence, Impella was associated with a significantly higher risk of short-term mortality (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.49–1.89), bleeding (OR 1.62, 95% CI 1.49–1.75), stroke (OR 2.67, 95% CI 1.01–7.03), AKI (OR 1.55, 95% CI 1.10–2.18), and AKI requiring dialysis (OR 1.67, 95% CI 1.50–1.87). Compared with control, Impella significantly increased the risk of stroke (OR 4.37, 95% CI 3.74–5.11). Randomized controlled trials (RCTs) have also supported an increased bleeding risk with Impella compared with IABP or standard care.
Conclusion: For STEMI patients with cardiogenic shock, IABP may be considered as a mechanical support option when hemodynamically feasible. By contrast, Impella has been associated with an unfavorable risk-benefit profile in this population in observational studies, which may be heavily influenced by patient selection and salvage use. Therefore, its application warrants careful consideration if escalation is necessary.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251002524 , PROSPERO CRD420251002524.
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BibTeX
@article{guan2026comparative,
title = {{Comparative efficacy and safety of mechanical circulatory support in ST-elevation myocardial infarction with cardiogenic shock: a network meta-analysis}},
author = {Boyu Guan and Xinsheng Li and Jiahua Zhang and Dongyuan Yu and Yujian Peng and Haichen Lv and Zhujing Hao},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.1782887},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1782887/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Comparative efficacy and safety of mechanical circulatory support in ST-elevation myocardial infarction with cardiogenic shock: a network meta-analysis
AU - Boyu Guan
AU - Xinsheng Li
AU - Jiahua Zhang
AU - Dongyuan Yu
AU - Yujian Peng
AU - Haichen Lv
AU - Zhujing Hao
PY - 2026
DA - 2026/10/28
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.1782887
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1782887/full
AB - Background: ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock carries high mortality, yet optimal treatment remains uncertain in this distinct patient population. The aim of this study is to systematically evaluate and compare the efficacy of mechanical circulatory support (MCS) devices, vasoactive agents, and inotropic agents in the management of critical adult patients with STEMI complicating cardiogenic shock. Methods: A network meta-analysis (PROSPERO CRD420251002524) was conducted, with systematic searches of six databases (Embase, Web of Science, PubMed, and Cochrane, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform) from inception to March 2025 for randomized and observational studies. We also updated the search to September 2026 using the same search strategy. Results: Data from 22 studies (pooled n = 360,235) revealed a predominantly male (65%), older adult population (mean age 67 years), US-based (97.9%) population with hypertension, hyperlipidemia, diabetes or heart failure. Compared with intra-aortic balloon pump (IABP), based on observational evidence, Impella was associated with a significantly higher risk of short-term mortality (odds ratio [OR] 1.68, 95% confidence interval [CI] 1.49–1.89), bleeding (OR 1.62, 95% CI 1.49–1.75), stroke (OR 2.67, 95% CI 1.01–7.03), AKI (OR 1.55, 95% CI 1.10–2.18), and AKI requiring dialysis (OR 1.67, 95% CI 1.50–1.87). Compared with control, Impella significantly increased the risk of stroke (OR 4.37, 95% CI 3.74–5.11). Randomized controlled trials (RCTs) have also supported an increased bleeding risk with Impella compared with IABP or standard care. Conclusion: For STEMI patients with cardiogenic shock, IABP may be considered as a mechanical support option when hemodynamically feasible. By contrast, Impella has been associated with an unfavorable risk-benefit profile in this population in observational studies, which may be heavily influenced by patient selection and salvage use. Therefore, its application warrants careful consideration if escalation is necessary. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251002524 , PROSPERO CRD420251002524.
SN - 2297-055X
ER -