Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump for Cardiogenic Shock

To the Editor Dr Dhruva and colleagues reported a higher risk of in-hospital death and bleeding complications in patients treated with an Impella device (intravascular microaxial left ventricular assist device [LVAD]) compared with an intra-aortic balloon pump (IABP) among patients with cardiogenic shock. Randomized clinical trials (RCTs) are expensive and time consuming; while trials are being conducted, retrospective observational studies can provide some insight. In cardiogenic shock, outcome is related to hemodynamic and metabolic state at the time of diagnosis. In this respect, registry data do not provide sufficient time-dependent information on hemodynamic and metabolic variables. We consider propensity matching on these variables important, since hemodynamic and metabolic data have prognostic value and, at the same time, are used to select patients for mechanical circulatory support.
Source: JAMA - Category: General Medicine Source Type: research