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Order of IABP insertion during primary PCI may impact infarct size
Insertion of an intra-aortic balloon pump before primary PCI compared with immediately afterward was associated with higher serum peak creatine kinase concentration, indicating a larger infarct size, but not with 30-day and late mortality, study results found.
Researchers at Erasmus University Medical Center, in Rotterdam, The Netherlands, enrolled 173 consecutive patients admitted with cardiogenic shock from STEMI and treated with primary PCI and an intra-aortic balloon pump (IABP) from 2000 and 2009. The order of IABP insertion and the stent was left to the interventional cardiologist’s discretion.
Cumulative 30-day mortality was 44% in patients who first received IABP and 37% in patients who received IABP directly after PCI (P=.39). Median peak serum creatine kinase (CK) concentrations were 5,692 U/L in those who received IABP first and 4,034 U/L in those who received it afterward (P=.048). IABP insertion before PCI was independently linked with higher CK levels (P=.046), indicating a larger infarct size. Among patients who survived 30 days, IABP insertion before PCI was not associated with late mortality at 5 year follow-up (HR=1.5; 95% CI, 0.7-3.3).
A possible explanation for the observed higher CK levels with IABP insertion before PCI may be the increased reperfusion delay due to the time required for insertion, the researchers wrote.
“As such, the results of the present study suggest that achievement of early reperfusion with primary PCI could have priority over routine early IABP insertion in STEMI patients with cardiogenic shock,” they said.
Disclosure: The researchers report no relevant financial disclosures.