TOPLINE

In patients who underwent complex high-risk and planned percutaneous coronary intervention (PCI), prophylactic mechanical circulatory support did not reduce the risk for short- or long-term major adverse cardiovascular events (MACE).

METHODOLOGY

• Researchers conducted a network meta-analysis pooling data from randomized trials to compare prophylactic mechanical circulatory support with standard care in patients who underwent planned, complex high-risk indicated PCI.
• They searched multiple sources and included eight trials involving 1856 patients in the final analysis. The mean age of patients was 66 years and 17.3% were women.
• Support devices were percutaneous left ventricular assist devices (LVAD), intra-aortic balloon pump (IABP), and venoarterial extracorporeal membrane oxygenation (VA-ECMO).
• A total of 727 patients received percutaneous LVAD, 512 IABP, 273 VA-ECMO, and 344 standard care.
• The primary efficacy outcome measured a composite of MACE. Secondary outcomes included death, myocardial infarction, and periprocedural major adverse events.

TAKEAWAY

• Standard care was compared with percutaneous LVAD in one trial, with IABP in two trials, and with VA-ECMO in one trial; four trials compared different devices. Risk for bias was judged low in two trials and six had some concerns, while heterogeneity was low to high across outcomes.
• At 30 days, none of the device strategies were associated with a lower risk for MACE compared with standard care.
• Compared with patients who received standard care, the risk for periprocedural major adverse events was lower in those who received percutaneous LVAD (risk ratio [RR], 0.30) and IABP (RR, 0.26; P = .03 for both).
• Over a mean follow-up duration of 10.8 months, none of the devices reduced the risk for MACE, stroke, myocardial infarction, or repeat revascularization. The finding was also true for the risk for death at a mean follow-up duration of 14.1 months.

IN PRACTICE

"[The] findings do not support routine prophylactic use and suggest that any potential role for MCS [mechanical circulatory support] should be limited to highly selected patients," the researchers wrote.

SOURCE

The study was led by Kamil Bujak, MD, PhD, of the University of Catania, Catania, Italy. It was published online on September 9 in the Journal of the American Heart Association.

LIMITATIONS

Researchers relied on aggregated trial data instead of patient-level data. Trials used different definitions for MACE and periprocedural adverse events. Some of the network comparisons had inconsistency.

DISCLOSURES

The study did not receive any specific funding. One author reported receiving support from NAWA (the Polish National Agency for Academic Exchange) and the Medical Research Agency. Another author reported receiving speaker honoraria from Abiomed.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.