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

Duke Clinical Research Institute, Durham, North Carolina, USA. ander040@onyx.mc.duke.edu

OBJECTIVES: We sought to examine the use, complications and outcomes with early intraaortic balloon counterpulsation (IABP) in patients presenting with cardiogenic shock complicating acute myocardial infarction and treated with thrombolytic therapy. BACKGROUND: The use of IABP in patients with cardiogenic shock is widely accepted; however, there is a paucity of information on the use of this technique in patients with cardiogenic shock who are treated with thrombolytic therapy. METHODS: Patients who presented within 6 h of chest pain onset were randomized to one of four thrombolytic regimens. Cardiogenic shock was not an exclusion criterion, and data for these patients were prospectively collected. Patients presenting with shock were classified into early IABP (insertion within one calendar day of enrollment) or no IABP (insertion on or after day 2 or never). RESULTS: There were 68 (22%) IABP placements in 310 patients presenting with shock. Early IABP use occurred in 62 patients (20%) and none in 248 (80%). Most IABP use occurred in the United States (59 of 68 IABP placements) involving 32% of U.S. patients presenting with shock. Despite more adverse events in the early IABP group and more episodes of moderate bleeding, this cohort showed a trend toward lower 30-day and 1-year mortality rates. CONCLUSIONS: IABP appears to be underutilized in patients presenting with cardiogenic shock, both within and outside the United States. Early IABP institution is associated with an increased risk of bleeding and adverse events but a trend toward lower 30-day and 1-year all-cause mortality.

This article has been cited by other articles:

				F.-C. Chiu, S.-N. Chang, J.-W. Lin, J.-J. Hwang, and Y.-S. Chen Coronary artery bypass graft surgery provides better survival in patients with acute coronary syndrome or ST-segment elevation myocardial infarction experiencing cardiogenic shock after percutaneous coronary intervention: A propensity score analysis J. Thorac. Cardiovasc. Surg., December 1, 2009; 138(6): 1326 - 1330. [Abstract] [Full Text] [PDF]

				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]

				C. S. Duvernoy and E. R. Bates Management of Cardiogenic Shock Attributable to Acute Myocardial Infarction in the Reperfusion Era J Intensive Care Med, July 1, 2005; 20(4): 188 - 198. [Abstract] [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]

				E. W. Chen, J. G. Canto, L. S. Parsons, E. D. Peterson, K. A. Littrell, N. R. Every, C. M. Gibson, J. S. Hochman, E. M. Ohman, M. Cheeks, et al. Relation Between Hospital Intra-Aortic Balloon Counterpulsation Volume and Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock Circulation, August 26, 2003; 108(8): 951 - 957. [Abstract] [Full Text] [PDF]

				R. Low Intra-aortic balloon counterpulsation in acute myocardial infarction: too few or too many? J. Am. Coll. Cardiol., June 4, 2003; 41(11): 1946 - 1947. [Full Text] [PDF]

				A. Dekker, K. Reesink, E. van der Veen, V. van Ommen, G. Geskes, C. Soemers, and J. Maessen Efficacy of a New Intraaortic Propeller Pump vs the Intraaortic Balloon Pump: An Animal Study Chest, June 1, 2003; 123(6): 2089 - 2095. [Abstract] [Full Text] [PDF]

				D.R Holmes The final common pathway Eur. Heart J., February 1, 2003; 24(3): 214 - 216. [Full Text] [PDF]

				L Carnendran, R Abboud, L.A Sleeper, R Gurunathan, J.G Webb, V Menon, V Dzavik, T Cocke, J.S Hochman, and for the SHOCK Investigators Trends in cardiogenic shock: report from the SHOCK Study Eur. Heart J., March 2, 2001; 22(6): 472 - 478. [Abstract] [PDF]

				C.H. Davies Revascularization for cardiogenic shock QJM, February 1, 2001; 94(2): 57 - 67. [Full Text] [PDF]

				V Menon, J.S Hochman, A Stebbins, M Pfisterer, J Col, R.D Anderson, D Hasdai, D.R Holmes Jr, E.R Bates, E.J Topol, et al. Lack of progress in cardiogenic shock: lessons from the GUSTO trials Eur. Heart J., December 1, 2000; 21(23): 1928 - 1936. [Abstract] [PDF]

				S. C. Wong, T. Sanborn, L. A. Sleeper, J. G. Webb, R. Pilchik, D. Hart, S. Mejnartowicz, T. A. Antonelli, R. Lange, J. K. French, et al. Angiographic findings and clinical correlates in patients with cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1077 - 1083. [Abstract] [Full Text] [PDF]

				T. A. Sanborn, L. A. Sleeper, E. R. Bates, A. K. Jacobs, J. Boland, J. K. French, J. Dens, V. Dzavik, S. T. Palmeri, J. G. Webb, et al. Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry J. Am. Coll. Cardiol., September 1, 2000; 36(3_Suppl_A): 1123 - 1129. [Abstract] [Full Text] [PDF]

				S. M. Hollenberg, C. J. Kavinsky, and J. E. Parrillo Cardiogenic Shock Ann Intern Med, July 6, 1999; 131(1): 47 - 59. [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]