{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:12:36Z","timestamp":1789517556886,"version":"build-2803163510"},"reference-count":35,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T00:00:00Z","timestamp":1657152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Heart Foundation Fellowship","award":["101908"],"award-info":[{"award-number":["101908"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Despite an increase in the use of mechanical circulatory support (MCS) devices for acute myocardial infarction cardiogenic shock (AMI-CS), there is currently no randomised data directly comparing the use of Impella and veno-arterial extra-corporeal membrane oxygenation (VA-ECMO). Methods: Electronic databases of MEDLINE, EMBASE and CENTRAL were systematically searched in November 2021. Studies directly comparing the use of Impella (CP, 2.5 or 5.0) with VA-ECMO for AMI-CS were included. Studies examining other modalities of MCS, or other causes of cardiogenic shock, were excluded. The primary outcome was in-hospital mortality. Results: No randomised trials comparing VA-ECMO to Impella in patients with AMI-CS were identified. Six cohort studies (five retrospective and one prospective) were included for systematic review. All studies, including 7093 patients, were included in meta-analysis. Five studies reported in-hospital mortality, which, when pooled, was 42.4% in the Impella group versus 50.1% in the VA-ECMO group. Impella support for AMI-CS was associated with an 11% relative risk reduction in in-hospital mortality compared to VA-ECMO (risk ratio 0.89; 95% CI 0.83\u20130.96, I2 0%). Of the six studies, three studies also adjusted outcome measures via propensity-score matching with reported reductions in in-hospital mortality with Impella compared to VA-ECMO (risk ratio 0.72; 95% CI 0.59\u20130.86, I2 35%). Pooled analysis of five studies with 6- or 12-month mortality data reported a 14% risk reduction with Impella over the medium-to-long-term (risk ratio 0.86; 95% CI 0.76\u20130.97, I2 0%). Conclusions: There is no high-level evidence comparing VA-ECMO and Impella in AMI-CS. In available observation studies, MCS with Impella was associated with a reduced risk of in-hospital and medium-term mortality as compared to VA-ECMO.<\/jats:p>","DOI":"10.3390\/jcm11143955","type":"journal-article","created":{"date-parts":[[2022,7,7]],"date-time":"2022-07-07T07:51:56Z","timestamp":1657180316000},"page":"3955","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Impella versus Venoarterial Extracorporeal Membrane Oxygenation for Acute Myocardial Infarction Cardiogenic Shock: A Systematic Review and Meta-Analysis"],"prefix":"10.3390","volume":"11","author":[{"given":"Riley J.","family":"Batchelor","sequence":"first","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia"},{"name":"Department of Cardiology, The Royal Melbourne Hospital, Melbourne 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Wheelahan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Western Health, Melbourne 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9071-6296","authenticated-orcid":false,"given":"Wayne C.","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8686-2709","authenticated-orcid":false,"given":"Dion","family":"Stub","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia"},{"name":"Department of Cardiology, Western Health, Melbourne 3004, Australia"},{"name":"Department of Epidemiology and Preventive Medicine, Monash University, Melbourne 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Yang","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Western Health, Melbourne 3004, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9684-888X","authenticated-orcid":false,"given":"William","family":"Chan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Alfred Hospital, 55 Commercial Road, Melbourne 3004, Australia"},{"name":"Department of Cardiology, Western Health, Melbourne 3004, Australia"},{"name":"Department of Medicine, University of Melbourne, Melbourne 3052, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2535","DOI":"10.1093\/eurheartj\/ehs264","article-title":"Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: A report from the USIK 1995, USIC 2000, and FAST-MI French nationwide registries","volume":"33","author":"Aissaoui","year":"2012","journal-title":"Eur. 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