{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T16:57:33Z","timestamp":1785776253129,"version":"3.56.0"},"reference-count":36,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Observational studies comparing Impella and venoarterial extracorporeal membrane oxygenation (VA\u2010ECMO) in cardiogenic shock have reported inconsistent findings. We performed an updated systematic review and meta\u2010analysis, with exploratory matched\u2010cohort analyses where directly reportable propensity score\u2013matched event\u2010level data were available. We searched PubMed, Scopus, Web of Science, and the Cochrane Library from inception through March 2026 for observational studies comparing Impella versus VA\u2010ECMO in adult patients with cardiogenic shock. The primary outcome was in\u2010hospital mortality. Secondary outcomes included all\u2010cause mortality, ICU outcomes, access site bleeding requiring transfusion, peripheral vascular complications, renal outcomes, and stroke. Random\u2010effects models using restricted maximum likelihood were applied. Fifteen observational studies including 22,618 patients were analyzed. In the primary crude analysis, Impella was not associated with a statistically significant difference in in\u2010hospital mortality (RR 0.84, 95% CI 0.66\u22121.07;\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.15) with substantial heterogeneity (\n                    <jats:italic>I<\/jats:italic>\n                    \u00b2\u2009=\u200992.9%). However, leave\u2010one\u2010out analysis identified an influential registry study; its exclusion markedly reduced heterogeneity and favored Impella (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). In exploratory propensity score\u2010matched analysis, Impella was also associated with lower in\u2010hospital mortality (RR 0.69, 95% CI 0.56\u22120.85,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). Thirty\u2010day and 6\u2010month all\u2010cause mortality were neutral, whereas 12\u2010month mortality modestly favored Impella (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.048). Sensitivity analyses similarly resolved heterogeneity and favored Impella for selected secondary outcomes, including 6\u2010month mortality, acute kidney injury, and ischemic stroke. ICU mortality was neutral, while ICU length of stay was shorter with Impella (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.01). Impella was also associated with lower access site bleeding requiring transfusion (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01), peripheral vascular complications (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01), and hemorrhagic stroke (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). In this updated meta\u2010analysis of observational studies, the primary crude analysis of in\u2010hospital mortality was neutral overall but highly heterogeneous, whereas sensitivity and exploratory matched\u2010cohort analyses showed a more consistent association favoring Impella. Impella was also associated with lower bleeding and vascular complications and shorter ICU length of stay, although several outcomes remained sensitive to study\u2010level influence. These findings should be interpreted cautiously given the observational design, predominance of serious risk of bias, and strong potential for confounding by indication.\n                  <\/jats:p>","DOI":"10.1002\/ccd.70658","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T04:01:02Z","timestamp":1778558462000},"page":"301-313","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impella Versus VA\u2010ECMO in Cardiogenic Shock: An Updated Systematic Review and Meta\u2010Analysis With Exploratory Matched\u2010Cohort Analyses"],"prefix":"10.1002","volume":"108","author":[{"given":"Ahmed Elmorsy","family":"Mohamed","sequence":"first","affiliation":[{"name":"New York University Langone Health  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Elnady","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Kafr Elsheikh University Kafr El\u2010Sheikh Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeyad","family":"Kholeif","sequence":"additional","affiliation":[{"name":"Department of Cardiology Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5122-8200","authenticated-orcid":false,"given":"Ameer","family":"Awashra","sequence":"additional","affiliation":[{"name":"Department of Medicine An Najah National University Nablus Palestine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed Sobhy","family":"Elsobky","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Menoufia University Menofia Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amr Ahmed","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Menoufia University Menofia Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdallah Osama","family":"Elfeky","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Menoufia University Menofia Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Shams","sequence":"additional","affiliation":[{"name":"New York University Langone Health  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rana","family":"Rashwan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine NYC Health and Hospitals\/Lincoln Bronx New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3778-1565","authenticated-orcid":false,"given":"Imad","family":"Tahhan","sequence":"additional","affiliation":[{"name":"Medical University of South Carolina Charleston South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohab","family":"Elnashar","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Arkansas for Medical Sciences Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranem","family":"Ayman","sequence":"additional","affiliation":[{"name":"New York University Langone Health  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mazen","family":"Hassanin","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Cairo University Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hisham","family":"Elharty","sequence":"additional","affiliation":[{"name":"New York University Langone Health  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diaa","family":"Hakim","sequence":"additional","affiliation":[{"name":"Brigham and Women's Hospital\/Harvard Medical School Boston Massachusetts 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Changing Trends in Mechanical Circulatory Support Utilization and Outcomes in Patients Undergoing Percutaneous Coronary Interventions for Acute Coronary Syndrome Complicated With Cardiogenic Shock: Insights from a Nationwide Registry in Japan. 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