Do DanGer-SHOCK-like patients benefit from VA-ECMO treatment in infarct-related cardiogenic shock? results of an individual patient data meta-analysis.

IF 3.9 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Uwe Zeymer, Anne Freund, Matthias Hochadel, Petr Ostadal, Jan Belohlavek, Steffen Massberg, Stefan Brunner, Marcus Flather, David Adlam, Christian Hassager, Jacob E Moeller, Steffen Schneider, Steffen Desch, Holger Thiele
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Abstract

Aims: In a recent meta-analysis of randomized controlled trials, routine use of veno-arterial ECMO (VA-ECMO) did not improve outcomes in patients with acute myocardial infarction-related cardiogenic shock (AMI-CS), while a microaxial flow pump reduced mortality in a selected group of patients with AMI-CS in the DanGer-Shock trial.

Methods and results: Individual patient data of patients included in four randomized clinical trials investigating the routine use of VA-ECMO in AMI-CS were centrally analysed. For the purpose of this sub-analysis, DanGer-Shock-like patients were analysed (STEMI only, presumed low likelihood of brain injury). The primary endpoint was 180-day all-cause mortality. A total of 202 patients (106 randomized to VA-ECMO and 96 to control) were included. There were no differences in baseline characteristics, angiographic and interventional features between the two groups. Mortality after 6 months was numerically lower with VA-ECMO between the groups [45% in VA-ECMO group vs. 51% in control group; hazard ratio, 0.84; 95% confidence interval (CI), 0.56-1.26], while major bleeding (OR, 2.24; 95% CI, 1.08-4.64) and peripheral vascular complications (OR, 3.65; 95% CI, 1.15-11.56) were increased with the use of VA-ECMO.

Conclusion: In this exploratory subgroup analysis in patients with CS, STEMI, and a low likelihood of brain injury, there was no mortality benefit with the routine use of VA-ECMO. However, as indicated by the large confidence intervals, the statistical power was limited to draw definite conclusions.

个体患者数据荟萃分析结果:DanGer-SHOCK-like 患者是否能从心梗相关性心源性休克的 VA-ECMO 治疗中获益?
目的:在最近一项随机对照试验的荟萃分析中,常规使用静脉-动脉 ECMO(VA-ECMO)并不能改善急性心肌梗死相关性心源性休克(AMI-CS)患者的预后,而在 DanGer-Shock 试验中,微轴血流泵降低了特定组别 AMI-CS 患者的死亡率:集中分析了四项随机临床试验中的患者个人数据,这些试验调查了VA-ECMO在AMI-CS中的常规使用情况。为了进行本次子分析,对类似 DanGer-Shock 的患者(仅 STEMI,推测脑损伤可能性较低)进行了分析。主要终点是 180 天全因死亡率。共纳入202名患者(106名随机接受VA-ECMO治疗,96名接受对照治疗)。两组患者的基线特征、血管造影和介入特征没有差异。使用VA-ECMO后,两组患者6个月后的死亡率在数字上有所降低[VA-ECMO组为45%,对照组为51%;危险比为0.84;95%置信区间(CI)为0.56-1.26],而大出血(OR,2.24;95% CI,1.08-4.64)和外周血管并发症(OR,3.65;95% CI,1.15-11.56)在使用VA-ECMO后有所增加:结论:在对 CS、STEMI 和脑损伤可能性较低的患者进行的探索性亚组分析中,常规使用 VA-ECMO 对死亡率没有益处。然而,正如较大的置信区间所显示的那样,得出明确结论的统计能力有限。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
8.50
自引率
4.90%
发文量
325
期刊介绍: The European Heart Journal - Acute Cardiovascular Care (EHJ-ACVC) offers a unique integrative approach by combining the expertise of the different sub specialties of cardiology, emergency and intensive care medicine in the management of patients with acute cardiovascular syndromes. Reading through the journal, cardiologists and all other healthcare professionals can access continuous updates that may help them to improve the quality of care and the outcome for patients with acute cardiovascular diseases.
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