Microaxial Flow Pump vs Standard Care in Infarct-Related Cardiogenic Shock
abstract
This abstract is available on the publisher's site.
Access this abstract nowBACKGROUND
The effects of temporary mechanical circulatory support with a microaxial flow pump on mortality among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock remains unclear.
METHODS
In an international, multicenter, randomized trial, we assigned patients with STEMI and cardiogenic shock to receive a microaxial flow pump (Impella CP) plus standard care or standard care alone. The primary end point was death from any cause at 180 days. A composite safety end point was severe bleeding, limb ischemia, hemolysis, device failure, or worsening aortic regurgitation.
RESULTS
A total of 360 patients underwent randomization, of whom 355 were included in the final analysis (179 in the microaxial-flow-pump group and 176 in the standard-care group). The median age of the patients was 67 years, and 79.2% were men. Death from any cause occurred in 82 of 179 patients (45.8%) in the microaxial-flow-pump group and in 103 of 176 patients (58.5%) in the standard-care group (hazard ratio, 0.74; 95% confidence interval [CI], 0.55 to 0.99; P = 0.04). A composite safety end-point event occurred in 43 patients (24.0%) in the microaxial-flow-pump group and in 11 (6.2%) in the standard-care group (relative risk, 4.74; 95% CI, 2.36 to 9.55). Renal-replacement therapy was administered to 75 patients (41.9%) in the microaxial-flow-pump group and to 47 patients (26.7%) in the standard-care group (relative risk, 1.98; 95% CI, 1.27 to 3.09).
CONCLUSIONS
The routine use of a microaxial flow pump with standard care in the treatment of patients with STEMI-related cardiogenic shock led to a lower risk of death from any cause at 180 days than standard care alone. The incidence of a composite of adverse events was higher with the use of the microaxial flow pump. (Funded by the Danish Heart Foundation and Abiomed; DanGer Shock ClinicalTrials.gov number, NCT01633502.).
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Additional Info
Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock
N. Engl. J. Med 2024 Apr 07;[EPub Ahead of Print], JE Møller, T Engstrøm, LO Jensen, H Eiskjær, N Mangner, A Polzin, PC Schulze, C Skurk, P Nordbeck, P Clemmensen, V Panoulas, S Zimmer, A Schäfer, N Werner, M Frydland, L Holmvang, J Kjærgaard, R Sørensen, J Lønborg, MG Lindholm, NLJ Udesen, A Junker, H Schmidt, CJ Terkelsen, S Christensen, EH Christiansen, A Linke, FJ Woitek, R Westenfeld, S Möbius-Winkler, K Wachtell, HB Ravn, JF Lassen, S Boesgaard, O Gerke, C HassagerFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.