TY - JOUR
T1 - Percutaneous micro-axial flow pump use during non-emergent high-risk PCI
T2 - Systematic review and meta-analysis
AU - Elbenawi, Hossam
AU - Doma, Mohamed
AU - Cangut, Busra
AU - Abdelgalil, Mahmoud Shaaban
AU - Khlidj, Yehya
AU - Thakurathi, Priyesh
AU - Hammad, Amer
AU - Mohammed, Fathia
AU - Almaadawy, Omar
AU - Farhoud, Hassan
AU - Ghaly, Ramy
AU - Khan, Ubaid
AU - Abdelkarim, Islam
AU - Zaaya, Morad
AU - Ibrahim, Ramzi
AU - Aqtash, Obadah
AU - Sadek, Yasser Ahmed
AU - Al-Azizi, Karim M.
AU - Lin, Chien Jung
AU - Goldsweig, Andrew M.
AU - Elbadawi, Ayman
AU - Stone, Gregg W.
AU - Elgendy, Islam Y.
N1 - Publisher Copyright:
© 2025 .
PY - 2025
Y1 - 2025
N2 - Background Percutaneous micro-axial flow pumps (mAFP) are increasingly used for hemodynamic support during high-risk percutaneous coronary interventions (PCI) despite limited evidence supporting their effectiveness. We conducted a meta-analysis to assess the effectiveness and safety of mAFP use during non-emergent high-risk PCI procedures. Methods Electronic databases were searched for studies comparing percutaneous mAFP versus control for non-emergent high-risk PCI. The primary outcome was the incidence of major adverse cardiac events (MACE). Results Eight studies (one randomized, seven observational) with 4688 patients were included. There were no significant differences in the risk of MACE within 30 days (RR 1.34; 95 % CI 0.73–2.47) or at 1 year (RR 1.08; 95 % CI 0.58–1.98) in patients treated with vs. without a mAFP during high-risk PCI. Nor was the risk of mortality different between groups. Peri-procedural complications, including acute kidney injury, major bleeding, blood transfusions, myocardial infarction, and stroke, were not increased with the mAFP. The subgroup of patients who received mAFP prior to PCI again had similar risk of MACE and mortality compared with the control. However, in this group, mAFP use was associated with higher in-hospital risks of major bleeding (RR 2.77; 95 % CI 1.28–5.98) and blood transfusion (RR 2.20; 95 % CI 1.17–4.15) and of in-hospital or 30-day myocardial infarction (RR 1.68; 95 % CI 1.03–2.73). Conclusions mAFP use was not associated with improved outcomes among patients undergoing non-emergent high-risk PCI. Given the potential for selection bias, ongoing large-scale randomized trials are necessary to determine its impact on efficacy and safety. Social media abstract In 4688 patients undergoing non-emergent high-risk PCI, use of a percutaneous micro-axial flow pump did not reduce MACE or mortality at 30 days or 6 months, and pre-PCI use was linked to higher risks of bleeding and in-hospital MI, warranting further large-scale trials.
AB - Background Percutaneous micro-axial flow pumps (mAFP) are increasingly used for hemodynamic support during high-risk percutaneous coronary interventions (PCI) despite limited evidence supporting their effectiveness. We conducted a meta-analysis to assess the effectiveness and safety of mAFP use during non-emergent high-risk PCI procedures. Methods Electronic databases were searched for studies comparing percutaneous mAFP versus control for non-emergent high-risk PCI. The primary outcome was the incidence of major adverse cardiac events (MACE). Results Eight studies (one randomized, seven observational) with 4688 patients were included. There were no significant differences in the risk of MACE within 30 days (RR 1.34; 95 % CI 0.73–2.47) or at 1 year (RR 1.08; 95 % CI 0.58–1.98) in patients treated with vs. without a mAFP during high-risk PCI. Nor was the risk of mortality different between groups. Peri-procedural complications, including acute kidney injury, major bleeding, blood transfusions, myocardial infarction, and stroke, were not increased with the mAFP. The subgroup of patients who received mAFP prior to PCI again had similar risk of MACE and mortality compared with the control. However, in this group, mAFP use was associated with higher in-hospital risks of major bleeding (RR 2.77; 95 % CI 1.28–5.98) and blood transfusion (RR 2.20; 95 % CI 1.17–4.15) and of in-hospital or 30-day myocardial infarction (RR 1.68; 95 % CI 1.03–2.73). Conclusions mAFP use was not associated with improved outcomes among patients undergoing non-emergent high-risk PCI. Given the potential for selection bias, ongoing large-scale randomized trials are necessary to determine its impact on efficacy and safety. Social media abstract In 4688 patients undergoing non-emergent high-risk PCI, use of a percutaneous micro-axial flow pump did not reduce MACE or mortality at 30 days or 6 months, and pre-PCI use was linked to higher risks of bleeding and in-hospital MI, warranting further large-scale trials.
KW - Impella
KW - Mechanical circulatory support
KW - Meta-analysis
KW - Micro-axial flow pumps
KW - Percutaneous coronary intervention
UR - https://www.scopus.com/pages/publications/105024998886
UR - https://www.scopus.com/pages/publications/105024998886#tab=citedBy
U2 - 10.1016/j.carrev.2025.10.019
DO - 10.1016/j.carrev.2025.10.019
M3 - Review article
C2 - 41238451
AN - SCOPUS:105024998886
SN - 1553-8389
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
ER -