Intra-aortic balloon counterpulsation in acute myocardial infarction: old and emerging indications

L X van Nunen, M van 't Veer, S Schampaert, B J E M Steerneman, M C M Rutten, F N van de Vosse, N H J Pijls, L X van Nunen, M van 't Veer, S Schampaert, B J E M Steerneman, M C M Rutten, F N van de Vosse, N H J Pijls

Abstract

Background: Recent evidence questions the role of intra-aortic balloon counterpulsation (IABP) in the treatment of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). An area of increasing interest is the use of IABP for persistent ischaemia (PI). We analysed the use of IABP in patients with AMI complicated by CS or PI.

Methods: From 2008 to 2010, a total of 4076 patients were admitted to our hospital for primary percutaneous coronary intervention (PCI) for AMI. Out of those, 239 patients received an IABP either because of CS or because of PI. Characteristics and outcome of those patients are investigated.

Results: The mean age of the study population was 64 ± 11 years; 75 % were male patients. Of the patients, 63 % had CS and 37 % had PI. Patients with CS had a 30-day mortality rate of 36 %; 1-year mortality was 41 %. Patients with PI had a 30-day mortality rate of 7 %; 1-year mortality was 11 %.

Conclusions: Mortality in patients admitted for primary PCI because of AMI complicated by CS is high despite IABP use. Outcome in patients treated with IABP for PI is favourable and mandates further prospective studies.

Figures

Fig. 1
Fig. 1
Flowchart. Patients admitted for acute myocardial infarction to the Catharina Hospital Eindhoven, period 2008–2010
Fig. 2
Fig. 2
One-year survival of patients treated with intra-aortic balloon counterpulsation. Panel A shows the Kaplan Meier curve of the patients treated with IABP for CS. Panel B shows the Kaplan Meier curve of the patients treated with IABP for PI

References

    1. Babaev A, Frederick PD, Pasta DJ, et al. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2005;294:448–54. doi: 10.1001/jama.294.4.448.
    1. Goldberg RJ, Spencer FA, Gore JM, et al. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009;119:1211–9. doi: 10.1161/CIRCULATIONAHA.108.814947.
    1. Kantrowitz A, Tjonneland S, Freed PS, et al. Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA. 1968;203:113–8. doi: 10.1001/jama.1968.03140020041011.
    1. Kern MJ, Aguirre FV, Tatineni S, et al. Enhanced coronary blood flow velocity during intraaortic balloon counterpulsation in critically ill patients. J Am Coll Cardiol. 1993;21:359–68. doi: 10.1016/0735-1097(93)90676-R.
    1. Prondzinsky R, Unverzagt S, Russ M, et al. Hemodynamic effects of intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP shock trial. Shock. 2012;37:378–84. doi: 10.1097/SHK.0b013e31824a67af.
    1. Sjauw KD, Engstrom AE, Vis MM, et al. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J. 2009;30:459–68. doi: 10.1093/eurheartj/ehn602.
    1. Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012;367:1287–96. doi: 10.1056/NEJMoa1208410.
    1. Pierrakos CN, Bonios MJ, Drakos SG, et al. Mechanical assistance by intra-aortic balloon pump counterpulsation during reperfusion increases coronary blood flow and mitigates the no-reflow phenomenon: an experimental study. Artif Organs. 2011;35:867–74. doi: 10.1111/j.1525-1594.2011.01241.x.
    1. Cheng JM, Valk SD, den Uil CA, et al. Usefulness of intra-aortic balloon pump counterpulsation in patients with cardiogenic shock from acute myocardial infarction. Am J Cardiol. 2009;104:327–32. doi: 10.1016/j.amjcard.2009.03.050.
    1. Mehta RH, Harjai KJ, Cox D, et al. Clinical and angiographic correlates and outcomes of suboptimal coronary flow in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. J Am Coll Cardiol. 2003;42:1739–46. doi: 10.1016/j.jacc.2003.07.012.
    1. Rezkalla SH, Dharmashankar KC, Abdalrahman IB, et al. No-reflow phenomenon following percutaneous coronary intervention for acute myocardial infarction: incidence, outcome, and effect of pharmacologic therapy. J Interv Cardiol. 2010;23:429–36. doi: 10.1111/j.1540-8183.2010.00561.x.
    1. Anderson RD, Ohman EM, Holmes DR, Jr, et al. Use of intraaortic balloon counterpulsation in patients presenting with cardiogenic shock: observations from the GUSTO-I study. Global utilization of streptokinase and TPA for occluded coronary arteries. J Am Coll Cardiol. 1997;30:708–15. doi: 10.1016/S0735-1097(97)00227-1.
    1. Barron HV, Every NR, Parsons LS, et al. The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2. Am Heart J. 2001;141:933–9. doi: 10.1067/mhj.2001.115295.
    1. Steg PG, James SK, Atar D, et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC) Eur Heart J. 2012;33:2569–619. doi: 10.1093/eurheartj/ehs289.
    1. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction) J Am Coll Cardiol. 2004;44:E1–211. doi: 10.1016/j.jacc.2004.07.014.
    1. Perera D, Lumley M, Pijls NH, et al. Intra-aortic balloon pump trials: questions, answers, and unresolved issues. Circ Cardiovasc Interv. 2013;6:317–21. doi: 10.1161/CIRCINTERVENTIONS.113.000336.
    1. Rezkalla SH, Kloner RA. No-reflow phenomenon. Circulation. 2002;105:656–62. doi: 10.1161/hc0502.102867.
    1. Pijls NH, De Bruyne B. Coronary pressure measurement and fractional flow reserve. Heart. 1998;80:539–42.
    1. Valk SD, Cheng JM, den Uil CA, et al. Encouraging survival rates in patients with acute myocardial infarction treated with an intra-aortic balloon pump. Neth Heart J. 2011;19:112–8. doi: 10.1007/s12471-010-0066-0.
    1. Patel MR, Smalling RW, Thiele H, et al. Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: the CRISP AMI randomized trial. JAMA. 2011;306:1329–37. doi: 10.1001/jama.2011.1280.
    1. Sjauw KD, Engstrom AE, Vis MM, et al. Efficacy and timing of intra-aortic counterpulsation in patients with ST-elevation myocardial infarction complicated by cardiogenic shock. Neth Heart J. 2012;20:402–9. doi: 10.1007/s12471-012-0312-8.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir