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Elective intra-aortic balloon pump did not reduce adverse event rate after PCI
Perera D. JAMA. 2010;304:867-874.
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Major adverse cardiac and CV events were not reduced in patients with severe left ventricular dysfunction and extensive coronary disease who had an intra-aortic balloon inserted before percutaneous coronary intervention, study results indicated.
The prospective, open, multicenter, randomized controlled trial was conducted in 17 tertiary referral cardiac centers in the United Kingdom between December 2005 and January 2009. Patients (n=301) had severe LV dysfunction (ejection fraction ≤30%) and extensive coronary disease (jeopardy score ≥8/12). The primary endpoint was major adverse cardiac and CV events defined as death, acute MI, cerebrovascular event or further revascularization at hospital discharge.
Of the study population, 151 received PCI with elective intra-aortic balloon pump (IABP) and 150 received PCI without IABP insertion. Major adverse cardiac and CV events occurred at hospital discharge in 15.2% (23/151) of patients with elective IABP and 16% (24/150) of those with no planned IABP. All-cause mortality at 6 months was 4.6% in the IABP group and 7.4% in the non-IABP group, with noticeably fewer major procedural complications in those with elective IABP insertion (1.3% vs. 10.7%; OR=0.11; 95% CI, 0.01-0.49).
“The study did not demonstrate a difference in [major adverse cardiac and CV events] at hospital discharge and therefore does not support routine elective IABP insertion before high-risk PCI,” the researchers said in the concluding statement of their study. “However, 12% of patients who underwent PCI without elective IABP insertion required rescue IABP support, which highlights the importance of adopting a standby IABP strategy when undertaking high-risk PCI.”
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