Left Ventricular Assist Devices for Acute Myocardial Infarct Size Reduction: Meta-analysis
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ORIGINAL ARTICLE
Left Ventricular Assist Devices for Acute Myocardial Infarct Size Reduction: Meta-analysis Satoshi Miyashita 1 & Taro Kariya 1 & Kelly P. Yamada 1 & Olympia Bikou 1 & Serena Tharakan 1 & Navin K. Kapur 2 & Kiyotake Ishikawa 1 Received: 11 June 2020 / Accepted: 10 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract We conducted a meta-analysis of preclinical studies that tested left ventricular assist device (LVAD) therapy for reducing myocardial infarct size in experimental acute myocardial infarction (AMI). Twenty-six articles were included with a total of 488 experimental animal subjects. The meta-analysis showed that infarct size was significantly decreased by LVAD support compared to control animals (SDM, − 2.19; 95% CI, − 2.70 to − 1.69; P < 0.001). The meta-regression analysis demonstrated a high degree of heterogeneity associated with time from coronary artery occlusion to LVAD support, which correlated positively with infarct size. Subgroup analysis suggested smaller infarct size in LVAD therapies that withdrew blood from left heart than those from right heart. The proportion of left ventricular support relative to total cardiac output was positively correlated with infarct size reduction in Impella studies. Thus, early initiation of LVAD after ischemia and effective left ventricular venting may be important factors to reduce infarct size in AMI. Keywords Infarct size . Ischemia reperfusion injury . LV unloading . Mechanical circulatory support
Abbreviations AMI Acute myocardial infarction IABP Intra-aortic balloon pump LA Left atrium LV Left ventricle LVAD Left ventricular assist device PRISMA Preferred reporting items for systematic reviews and meta-analyses Editor-in-Chief Enrique Lara-Pezzi oversaw the review of this article Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12265-020-10068-7) contains supplementary material, which is available to authorized users. * Kiyotake Ishikawa [email protected] 1
Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
2
CardioVascular Center for Research and Innovation, Tufts Medical Center, Boston, MA, USA
SD SDM STEMI–DTU
Standard deviation Standard difference of mean Door-to-Unload ST–Elevation Myocardial Infarction
Introduction Acute myocardial infarction (AMI) has an annual incidence of approximately 7.29 million episodes worldwide and is a leading cause of death. [1, 2] Guidelines from the American College of Cardiology/American Heart Association for the management of AMI [3] recommend rapid reperfusion of an occluded coronary artery to limit myocardial ischemic injury. Although percutaneous coronary intervention has dramatically decreased acute mortality from AMI [4, 5], the 5-year rate of heart failure development increased by 25% [6] and 1month mortality following AMI remains around 5% [4, 7]. It is also known that every 5% increase in myocardial infarct si
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