Concurrent intra-aortic balloon pump and veno-arterial extracorporeal membrane oxygenation for acute coronary syndrome-related cardiogenic shock: A meta-analysis of multivariate studies

TL;DR

Combining IABP and ECMO reduces short-term death risk in patients with heart failure from acute coronary syndrome, especially in male-dominated studies.

Contribution

This meta-analysis provides the first evidence that concurrent IABP and ECMO independently reduce mortality in ACS-related cardiogenic shock.

Findings

Concurrent IABP and ECMO reduced short-term mortality with an adjusted risk ratio of 0.64.

The proportion of men in studies fully explained the heterogeneity in results.

Subgroup analyses confirmed consistent benefits across different study designs and patient groups.

Abstract

Concurrent intra-aortic balloon pump (IABP) use has been suggested to reduce mortality in patients with acute coronary syndrome (ACS)-related cardiogenic shock (CS) on veno-arterial extracorporeal membrane oxygenation (ECMO). However, this observation is primarily based on small-scale univariate studies. The aim of this meta-analysis was to evaluate whether concurrent IABP and ECMO were independently associated with reduced mortality in patients with ACS-related CS. We searched Medline, Web of Science, and Embase for studies published up to May 28, 2024. The inclusion criteria were longitudinal observational studies comparing concurrent IABP and ECMO to ECMO alone in ACS-related CS patients, reporting all-cause mortality with multivariate adjustments. The primary outcome was the risk ratio (RR) of short-term mortality. A random-effects model incorporating heterogeneity was used to pool the results. Seven cohort studies, involving 5467 patients, were included. Concurrent IABP and ECMO were associated with a significant reduction in short-term mortality (adjusted RR: 0.64; 95% CI: 0.48–0.87, P ═ 0.005; I2 ═ 83%). Sensitivity analyses confirmed the robustness of these results. Meta-regression indicated that the proportion of men in each study significantly influenced the outcomes, fully explaining the heterogeneity (I2 residual ═ 0%). Subgroup analyses showed consistent results across various study designs, patient ages, observational durations, and study quality scores. In conclusion, concurrent IABP and ECMO are independently associated with reduced short-term mortality in ACS-related CS patients, particularly in studies with higher proportions of men. These findings support the potential benefits of combined mechanical support in this high-risk population.

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