Aortic counterpulsation may improve late patency of the occluded coronary artery in patients with early failure of thrombolytic therapy

Osaka Mishima Critical Care Medical Center, Japan.

OBJECTIVES: Using a prospective, randomized design, we tested our hypothesis that the augmentation of diastolic pressure by intraaortic balloon counterpulsation (IABP) would improve the late patency of the occluded coronary artery in patients with early failure of thrombolytic therapy. BACKGROUND: Rescue angioplasty is often performed in patients in whom thrombolysis has failed, although 30% to 60% of the infarct-related arteries that are closed early after thrombolytic therapy will open later with conservative therapy. METHODS: The study included 45 patients in whom thrombolysis had failed, despite treatment with intravenous tissue-type plasminogen activator (alteplase 0.75 mg/kg body weight) delivered over 60 min within 12 h of the onset of symptoms. All patients underwent coronary angiography 60 min after initiation of thrombolytic therapy (baseline), and Thrombolysis in Myocardial Infarction (TIMI) grade 0, 1 or 2 flow was defined as failed thrombolysis. The patients were randomized to groups receiving IABP for 48 h (n = 23) or conservative therapy (n = 22, control subjects) at the end of cardiac catheterization. The late patency of the infarct-related artery, the primary end point of the study, was evaluated 3 weeks after myocardial infarction. Stenosis of the infarct-related artery was measured using a computer-assisted quantitative angiographic system in blinded manner. Data are expressed as mean value +/- SEM. RESULTS: There was no difference with regard to the baseline value for TIMI flow grade between the groups. However, 3 weeks after myocardial infarction, the patients treated with IABP had a significantly higher frequency of TIMI flow grade 3, lower residual percent stenosis and larger minimal lumen diameter of the infarct-related artery than did the control subjects (74% vs. 32%, p < 0.05; 42 +/- 5% vs. 68 +/- 6%, p < 0.01; and 1.6 +/- 0.1 vs. 0.9 +/- 0.2 mm, p < 0.01, respectively). CONCLUSIONS: These findings suggest that in patients with early failure of thrombolytic therapy, IABP may improve late patency of the occluded coronary artery, probably due to augmented perfusion pressure.

This article has been cited by other articles:

				K. D. Sjauw, A. E. Engstrom, M. M. Vis, R. J. van der Schaaf, J. Baan Jr, K. T. Koch, R. J. de Winter, J. J. Piek, J. G.P. Tijssen, and J. P.S. Henriques 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., February 2, 2009; 30(4): 459 - 468. [Abstract] [Full Text] [PDF]

				A. O. Adesanya, J. A. de Lemos, N. B. Greilich, and C. W. Whitten Management of perioperative myocardial infarction in noncardiac surgical patients. Chest, August 1, 2006; 130(2): 584 - 596. [Abstract] [Full Text] [PDF]

				L. C. Amado, D. L. Kraitchman, B. L. Gerber, E. Castillo, R. C. Boston, J. Grayzel, and J. A. C. Lima Reduction of "no-reflow" phenomenon by intra-aortic balloon counterpulsation in a randomized magnetic resonance imaging experimental study J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1291 - 1298. [Abstract] [Full Text] [PDF]

				J.D. Kovac and A.H. Gershlick How should we detect and manage failed thrombolysis? Eur. Heart J., March 2, 2001; 22(6): 450 - 457. [PDF]

				A G C Sutton, P G Campbell, E D Grech, D J A Price, A Davies, J A Hall, M J Stewart, and M A de Belder Failure of thrombolysis: experience with a policy of early angiography and rescue angioplasty for electrocardiographic evidence of failed thrombolysis Heart, August 1, 2000; 84(2): 197 - 204. [Abstract] [Full Text] [PDF]

				S. Deniz Kumbasar, E. Semiz, O. Sancaktar, S. Yalcinkaya, C. Ermis, and N. Deger Concomitant Use of Intraaortic Balloon Counterpulsation and Streptokinase in Acute Anterior Myocardial Infarction Angiology, June 1, 1999; 50(6): 465 - 471. [Abstract] [PDF]

				A.W.J. van 't Hof, A.L. Liem, M.J. de Boer, J.C.A. Hoorntje, H. Suryapranata, and F. Zijlstra A randomized comparison of intra-aortic balloon pumping after primary coronary angioplasty in high risk patients with acute myocardial infarction Eur. Heart J., May 1, 1999; 20(9): 659 - 665. [Abstract] [PDF]

				R. Gitter, C. M. Cate, K. Smart, and G. K. Jett Influence of Ascending Versus Descending Balloon Counterpulsation on Bypass Graft Blood Flow Ann. Thorac. Surg., February 1, 1998; 65(2): 365 - 370. [Abstract] [Full Text] [PDF]