IABP before PCI improves outcomes in patients with cardiogenic shock
MedWire News: Results of a small study suggest that insertion of intra-aortic balloon pump counterpulsation (IABP) before rather than after primary percutaneous coronary intervention (PCI) improves survival of patients with cardiogenic shock complicating acute myocardial infarction (AMI).
“Our data suggest that delayed use of mechanical circulatory support might mitigate its potential benefits, which seem to be greatest in the early hours of AMI, probably even before recanalization of the infarct-related artery,” say the authors.
Despite a wealth of data supporting use of IABP in the setting of cardiogenic shock complicating AMI, a recently published meta-analysis questioned the benefit of IABP support, challenging current guidelines recommendations, explain Mohamed Abdel-Wahab and colleagues from the University of Kiel in Bad Segeberg, Germany.
To test if any benefit could depend on whether pumping is started before or after primary PCI, the researchers studied outcomes of 48 patients who had undergone primary PCI with IABP because of cardiogenic shock complicating AMI. The team compared outcomes of 26 patients who received the IABP before with those of 22 patients who received IABP after primary PCI. There were no significant differences in baseline characteristics between the two groups.
In-hospital mortality and overall incidence of major adverse cardiac and cerebrovascular events were significantly lower in the group of patients receiving the IABP before than in those receiving IABP after primary PCI, at 19% versus 59% (p=0.007) and 23% versus 77% (p=0.0004), respectively.
IABP insertion after PCI was one of only two independent predictors of in-hospital mortality in multivariable analysis, increasing the odds of death 5.2 fold. The other independently predictive factor was renal failure, at an odds ratio of 15.2.
Major bleeding was numerically higher in the IABP-assisted primary PCI, the authors note, and “the simultaneous puncture of both femoral arteries with the possibility of greater rates of access site complications remains a significant limitation to this approach.”
However, this did not affect the overall benefit of this approach short term – and “it seems that the favorable effect of IABP assistance in this setting might outweigh its potential risks,” they remark in the American Journal of Cardiology.
The researchers conclude that “the results clearly point to a favorable outcome associated with the early use of IABP, warranting additional study in larger prospective studies.”
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By Caroline Price