Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial.
Divaka Perera,Rodney H. Stables,Martyn Thomas,Jean Booth,Michael Pitt,Daniel J. Blackman,Adam de Belder,Simon Redwood +7 more
TL;DR: The results do not support a strategy of routine IABP placement before PCI in all patients with severe left ventricular dysfunction and extensive coronary disease and suggest that routine intra-aortic balloon counterpulsation before PCI should be dropped.
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Abstract: Context Observational studies have previously reported that elective intra-aortic balloon pump (IABP) insertion may improve outcomes following high-risk percutaneous coronary intervention (PCI). To date, this assertion has not been tested in a randomized trial. Objective To determine whether routine intra-aortic balloon counterpulsation before PCI reduces major adverse cardiac and cardiovascular events (MACCE) in patients with severe left ventricular dysfunction and extensive coronary disease. Design, Setting, and Patients The Balloon Pump–Assisted Coronary Intervention Study, a prospective, open, multicenter, randomized controlled trial conducted in 17 tertiary referral cardiac centers in the United Kingdom between December 2005 and January 2009. Patients (n = 301) had severe left ventricular dysfunction (ejection fraction ≤30%) and extensive coronary disease (Jeopardy Score ≥8/12); those with contraindications to or class I indications for IABP therapy were excluded. Intervention Elective insertion of IABP before PCI. Main Outcome Measures Primary end point was MACCE, defined as death, acute myocardial infarction, cerebrovascular event, or further revascularization at hospital discharge (capped at 28 days). Secondary end points included all-cause mortality at 6 months, major procedural complications, bleeding, and access-site complications. Results MACCE at hospital discharge occurred in 15.2% (23/151) of the elective IABP and 16.0% (24/150) of the no planned IABP groups (P = .85; odds ratio [OR], 0.94 [95% confidence interval {CI}, 0.51-1.76]). All-cause mortality at 6 months was 4.6% and 7.4% in the respective groups (P = .32; OR, 0.61 [95% CI, 0.24-1.62]). Fewer major procedural complications occurred with elective IABP insertion compared with no planned IABP use (1.3% vs 10.7%, P Conclusions Elective IABP insertion did not reduce the incidence of MACCE following PCI. These results do not support a strategy of routine IABP placement before PCI in all patients with severe left ventricular dysfunction and extensive coronary disease. Trial Registration isrctn.org Identifier: ISRCTN40553718; clinicaltrials.gov Identifier: NCT00910481
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Citations
Temporal Trends of In-Hospital Mortality in Patients Treated with Intra-Aortic Balloon Pumping: A Nationwide Population Study in Taiwan, 1998-2008.
TL;DR: The in-hospital mortality rate of IABP treatment decreased annually in Taiwan during the study period, however, high-risk patients who underwent coronary revascularization with IABp had a higher and unstable in- hospital mortality rate.
Intra-Aortic Balloon Pump for Patients with Cardiac Conditions: An Update on Available Techniques and Clinical Applications
Vanessa M. Limbert,Amir Mohammad Amiri +1 more
- 01 Aug 2019
TL;DR: A review of the intra-aortic balloon pump, as well as the usage of it in the medical field today, and the complications and state changes that occurred due to them are explained.
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Stable coronary artery disease
Robert A. Henderson,Adam Timmis +1 more
TL;DR: Encouraging data from Denmark and the UK showing declining mortality and also a sharp fall in standardised incidence rates for acute myocardial infarction indicate that coronary prevention, as well as acute treatments, has contributed to recent mortality trends.
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The Use of Intra-aortic Balloon Pump in a Real-World Setting: A Comparison between Survivors and Nonsurvivors from Acute Coronary Syndrome Treated with IABP. The Jakarta Acute Coronary Syndrome Registry
TL;DR: In ACS patients presenting with either cardiogenic shock, resuscitated, or patients who needed mechanical ventilation suffered from high mortality, despite the use of IABP, according to a real-world ACS registry evaluation.
Rescue venoarterial ECMO in cardiogenic shock complicated by refractory cardiac arrest during percutaneous coronary intervention
TL;DR: A case of profound cardiac shock due to complicated coronary artery disease, recurrent cardiac arrest during PCI, intraarrest PCI intra-aortic balloon pump insertion and successful resuscitation after venoarterial ECMO placement is described.
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