Left ventricular assist device versus intra-aortic balloon pump for treatment of acute myocardial infarction complicated by cardiogenic shock: a systematic review and meta-analysis
Bibliographic record
Abstract
Abstract Background 1. Despite early revascularization, the mortality of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) remains high. 2. Mechanical circulation support devices (MCS) are widely utilized in clinical due to unloading left ventricle and augmenting cardiac output. 3. Whether left ventricular assist device (LVAD) including TandemHeart and Impella is superior to Intra-aortic balloon pump (IABP) for AMI-CS remains unclear. Aim To investigate the efficacy and safety of LVAD versus IABP for AMI-CS. Methods 1. We searched the relevant literature on PUBMED, EMBASE and Cochrane Library. 2. The primary endpoint was 30-day mortality. The secondary endpoints were in-hospital myocardial infarction (MI), stent thrombosis (ST), stroke, sepsis, major bleeding and limb ischemia. 3. Two investigators performed the studies selection and data extraction independently. 4. The quality of randomized controlled trials and observational studies was assessed by using the Cochrane Collaboration's tool and Newcastle-Ottawa Scale respectively. 5. Results were analyzed by computing pooled risk ratios (RR) with 95% Confidence Intervals (CIs). Results 1. The process of literature search strategy is shown in Figure 1. 2. Main characteristics of the included studies can be seen in Table 1. 3. There was no significant difference in 30-day mortality (RR:0.97, 95% CI:0.80–1.17, P=0.76), in-hospital MI (RR:0.64, 95% CI:0.22–1.85, P=0.41), ST (RR:0.74, 95% CI:0.13–4.12, P=0.73), stroke (RR:1.36, 95% CI:0.37–4.94, P=0.64) and sepsis (RR:1.30, 95% CI:0.54–3.13, P=0.56) between LVAD and IABP group. However, the incidences of in-hospital major bleeding (RR:2.61,95% CI:1.61–4.23, P=0.0001) and limb ischemia (RR:4.91, 95% CI:2.07–11.64, P=0.0003) were significantly higher in LVAD than IABP group. Conclusion LVAD was not associated with reduced 30-day mortality but with increased in-hospital major bleeding and limb ischemia for patients with AMI-CS compared with IABP. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): National 135 Key Research and Development Program in 2016
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.015 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.019 | 0.023 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".