{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T02:12:05Z","timestamp":1789006325277,"version":"build-2803163510"},"reference-count":41,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,9,7]],"date-time":"2020-09-07T00:00:00Z","timestamp":1599436800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Mechanical circulatory support (MCS) with Impella or intra\u2010aortic balloon pump (IABP) is used for high\u2010risk percutaneous coronary intervention (PCI) and\/or for cardiogenic shock (CS) due to acute myocardial infarction. We aimed to investigate the efficacy and safety of Impella or IABP when compared with no MCS using a network meta\u2010analysis of randomized controlled trials (RCTs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>EMBASE and MEDLINE were searched through February 2020 for RCT evaluating efficacy of Impella vs. IABP vs. no MCS in patients undergoing high\u2010risk PCI or CS. The primary efficacy outcome was 30\u2009day or in\u2010hospital all\u2010cause mortality whereas the primary safety outcomes were major bleeding and vascular complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Our search identified nine RCTs enrolling a total of 1,996 patients with high\u2010risk PCI and\/or CS. There was no significant difference with Impella or IABP on all\u2010cause mortality when compared with no MCS (Impella vs. no MCS; OR:0.82 [0.35\u20131.90], <jats:italic>p<\/jats:italic> = .65, IABP vs. no MCS; OR:0.77 [0.47\u20131.28], <jats:italic>p<\/jats:italic> = .31, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup> = 18.1%). Impella significantly increased major bleeding compared with no MCS (Impella vs. no MCS; OR:7.01 [1.11\u201344.4], <jats:italic>p<\/jats:italic> = .038, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup> = 19.2%). IABP did not increase the risk of major bleeding compared with no MCS (OR:1.27 [0.75\u20132.16], <jats:italic>p<\/jats:italic> = .38, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup> = 19.2%) but increased vascular complication compared with no MCS (OR:1.92 [1.01\u20133.64], <jats:italic>p<\/jats:italic> = .045, <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup> = 1.5%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Neither Impella nor IABP decreased all\u2010cause short\u2010term mortality when compared with no MCS for high\u2010risk PCI and\/or CS. Moreover, Impella increased major bleeding compared with no MCS.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.29236","type":"journal-article","created":{"date-parts":[[2020,9,25]],"date-time":"2020-09-25T16:11:06Z","timestamp":1601050266000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Safety and efficacy of mechanical circulatory support with Impella or intra\u2010aortic balloon pump for high\u2010risk percutaneous coronary intervention and\/or cardiogenic shock: Insights from a network meta\u2010analysis of randomized trials"],"prefix":"10.1002","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2487-8366","authenticated-orcid":false,"given":"Toshiki","family":"Kuno","sequence":"first","affiliation":[{"name":"Department of Medicine Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel  New York New 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