Comparison of temporary mechanical circulatory support devices for patients with cardiogenic shock after acute myocardial infarction: A network meta-analysis of randomized controlled trials

Background: Despite the high mortality of cardiogenic shock after acute myocardial infarction (AMI-CS), the comparative efficacy and safety of mechanical circulatory support (MCS) in patients with AMI-CS is unknown. This study aimed to compare the efficacy and safety of various MCS with initial medical therapy for AMI-CS patients. Methods: We searched PubMed and EMBASE in July 2024. Randomized controlled trials (RCTs) comparing at least any of the following 2 were included: initial medical therapy, intra-aortic balloon pump (IABP), percutaneous ventricular assist device (pVAD), or extracorporeal membrane oxygenation (ECMO). We performed a network meta-analysis using a frequentist approach. The primary outcome was mid-term (6–12 months) mortality. The secondary outcomes were short-term (30-day or in-hospital) mortality, major bleeding, and vascular complications. Results: We included a total of 1845 patients with AMI-CS from 14 RCTs. There was no significant difference in short-term mortality between the treatment groups. However, pVAD and ECMO were associated with higher risks of major bleeding and vascular complications compared to initial medical therapy. Compared to initial medical therapy, pVAD (hazard ratio [HR], 0.77; 95 % confidence interval [CI], 0.60–1.00; p = 0.054) and ECMO (HR, 0.51; 95 % CI, 0.26–1.01; p = 0.054) were associated with the marginal benefits in reducing mid-term mortality. Conclusions: In our study, there was no significant benefits of MCS devices in reducing short-term mortality, and pVAD and ECMO were associated with a higher incidence of major bleeding and vascular complications. Although not statistically significant, MCS showed a favorable trend in mid-term mortality.