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Intra-aortic balloon counterpulsation failed to reduce MI size in patients with acute anterior MI without shock
Patel MR. JAMA. 2011;doi:10.1001/jama.2011.1280.
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A routine strategy of intra-aortic balloon counterpulsation before percutaneous coronary intervention did not lead to reduction of MI size in patients with high-risk anterior STEMI without shock vs. patients who underwent percutaneous coronary intervention alone, according to a study.
The Counterpulsation to Reduce Infarct Size Pre-PCI Acute MI trial was an open, multicenter, randomized controlled study funded by Maquet. Researchers wanted to determine whether a routine strategy of intra-aortic balloon counterpulsation (IABC) insertion before primary PCI could reduce infarct size in 337 patients with acute anterior STEMI without cardiogenic shock.
Patients were randomly assigned to two groups. The first group had the intra-aortic balloon inserted and pumping before PCI, and the second group underwent primary PCI alone. Researchers also performed standard sequences of cardiac MRI for microvascular obstruction, area at risk, left ventricular dimensions and function. Patients included in the study had to have 6 hours of chest pain onset and planned primary PCI for acute anterior STEMI with significant myocardium at risk.
The IABC plus PCI group had 161 patients and the PCI-alone group had 176 patients. According to the study, most patients received PCI. The mean infarct size between the IABC plus PCI group and the PCI-alone group was not significantly different. This includes all patients with proximal left anterior descending and thrombolysis in MI flow scores of 0 and 1.
“The left anterior descending was the infarct-related artery in 99.4% of the patients in the IABC plus PCI group and in 96% of the patients in the PCI alone group; more than 60% of patients in both groups had total occlusion,” according to researchers.
Researchers followed up for clinical events in patients at 30 days and 6 months. At 30 days, five patients in the IABC plus PCI group experienced major bleeding or transfusion vs. three patients in the PCI-along group. Seven IABC plus PCI patients also experienced major vascular complications vs. two patients in the PCI-alone group. According to researchers, at 6 months, three patients in the IABC plus PCI group and nine patients in the PCI-alone group had died, but the time to the composite endpoint of death, recurrent MI, or new or worsening HF was not significantly different between the two groups.
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