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A systematic literature review and meta-analysis of impella devices used in cardiogenic shock and high risk percutaneous coronary interventions

Jonathan Hill, Adrian Banning, Francesco Burzotta, Alaide Chieffo, Bernhard Schieffer, Andreas Schafer, Natalia MStelmaszuk-Zadykowicz, Sun Sun, Tim Spelman, Sagar Doshi, Nikos Werner, Markus W Ferrari, Alastair Proudfoot, Laurent Baradon, Theodore Schreiber, Perwaiz Meraj, Mark B Anderson, William W OA Neill

Background: To perform a meta-analysis on pooled survival and complications rates of Impella® heart pumps (Abiomed Inc., Danvers, USA) use in cardiogenic shock and high-risk coronary percutaneous coronary intervention (PCI). Methods and Findings: Articles were searched in Medline, Medline In-Process, EMBASE and the CENTRAL bibliographic databases on the 30th April, 2017. Prospective and retrospective studies with ≥10 patients supported with Impella. Survival and complication rates were pooled. The literature review identified 33 articles. Data on patient characteristics, indication of support, type of Impella device and outcomes were extracted. A random effect was used to pool the various outcomes. Low heterogeneity (I2 ≤0.25) results are presented. A total of 2,827 patients (40.5% cardiogenic shock, 59.5% high-risk PCI) were included (mean age 64.9±11.4, male 74.6%). In the cardiogenic shock indication, survival rate to 90 and 180 days was 62.6% and 58.3%, respectively; the rates of hemolysis and device malfunction were 8.8% and 2.5%, respectively. In the high-risk PCI indication, the 30 day major adverse cardiac and cerebrovascular event (MACCE) rate was 15.3% with a 30 day survival, stroke, myocardial infarction and repeat revascularization rates of 92.2%, 0.3%, 13.5% and 1.6%, respectively. Hemolysis and device malfunction affected respectively 0.7% and 1.4% of the high-risk PCI patients. Conclusions: This is the largest meta-analysis summarizing the literature outcome data of Impella heart pumps. The present study demonstrates very encouraging survival in cardiogenic shock patients and very good 30 day outcomes in patients undergoing prophylactic support for high-risk PCI.