- Question
- To determine whether adding a microaxial flow pump to standard care lowers mortality in patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock.
- Design
- International, multicenter, randomized, unblinded trial that assigned 360 patients; 355 were included in the final analysis (179 in the pump group and 176 in the standard-care group).
- Population
- Patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock. Median age was 67 years and 79.2% were men.
- Intervention
- Microaxial flow pump (Impella CP) plus standard care.
- Control
- Standard care alone.
- Primary outcome
- Death from any cause at 180 days.
- Results
- Death from any cause occurred in 82 of 179 patients (45.8%) with the pump and in 103 of 176 (58.5%) with standard care (HR 0.74; 95% CI 0.55 to 0.99; P = 0.04).
- Safety
- The composite safety end point (severe bleeding, limb ischemia, hemolysis, device failure, or worsening aortic regurgitation) occurred in 43 patients (24.0%) with the pump and in 11 (6.2%) with standard care (RR 4.74; 95% CI 2.36 to 9.55). Renal-replacement therapy was given to 75 patients (41.9%) with the pump and 47 (26.7%) with standard care (RR 1.98; 95% CI 1.27 to 3.09).
- Conclusion
- Routine use of the microaxial flow pump alongside standard care lowered the risk of death from any cause at 180 days compared with standard care alone, at the cost of more adverse events.
- Why it matters
- It was the first randomized trial to show a mortality benefit with temporary mechanical circulatory support in infarct-related cardiogenic shock, reigniting debate about selective use of the device weighed against its higher complication risk.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 7, 2026