CLINICAL RESEARCH: ACUTE MYOCARDIAL ISCHEMIA/INFARCTION
Contemporary utilization and outcomes of intra-aortic balloon counterpulsation in acute myocardial infarction
The benchmark registry
Gregg W. Stone, MD, FACC*,*,
E. Magnus Ohman, MD, FACC ,
Michael F. Miller, PhD ,
Debra L. Joseph, BSN ,
Jan T. Christenson, MD, FECTS||,
Marc Cohen, MD, FACC¶,
Philip M. Urban, MD, FACC#,
Ramachandra C. Reddy, MD, FACC**,
Robert J. Freedman, MD, FACC,
Karen L. Staman, MS and
James J. Ferguson, III, MD, FACC
* Cardiovascular Research Foundation and Lenox Hill Hospital, New York, New York, USA
University of North Carolina, Chapel Hill, North Carolina, USA
M. F. Miller Statistical Services, Langhorne, Pennsylvania, USA
Datascope Corp., Fairfield, New Jersey, USA
|| University of Geneva Hospital, Geneva, Switzerland
¶ Hahnemann University Hospital, Philadelphia, Pennsylvania, USA
# Hôpital de la Tour, Geneva, Switzerland
** State University of New York Health Science Center, Brooklyn, New York, USA
St. Francis Cabrini Medical Center, Alexandria, Louisiana, USA
Duke Clinical Research Institute, Durham, North Carolina, USA
Texas Heart Institute, Houston, Texas, USA
Manuscript received April 15, 2002;
revised manuscript received September 4, 2002,
accepted September 20, 2002.
* Reprint requests and correspondence: Dr. Gregg W. Stone, Cardiovascular Research Foundation, 55 East 59th Street, 6th Floor, New York, New York 10022, USA.
gstone{at}crf.org
OBJECTIVES: We sought to examine contemporary utilization patterns and clinical outcomes in patients with acute myocardial infarction (AMI) requiring intra-aortic balloon pump (IABP) counterpulsation.
BACKGROUND: Despite increasing experience with and broadened indications for intra-aortic counterpulsation, the current indications, associated complications, and clinical outcomes of IABP use in AMI are unknown.
METHODS: Between June 1996 and August 2001, data were prospectively collected from 22,663 consecutive patients treated with aortic counterpulsation at 250 medical centers worldwide; 5,495 of these patients had AMI.
RESULTS: Placement of an IABP in AMI patients was most frequently indicated for cardiogenic shock (27.3%), hemodynamic support during catheterization and/or angioplasty (27.2%) or prior to high-risk surgery (11.2%), mechanical complications of AMI (11.7%), and refractory post-myocardial infarction unstable angina (10.0%). Balloon insertions were successful in 97.7% of patients. Diagnostic catheterization was performed in 96% of patients, and 83% underwent coronary revascularization before hospital discharge. The in-hospital mortality rate was 20.0% (38.7% in patients with shock) and varied markedly by indication and use of revascularization procedures. Major IABP complications occurred in only 2.7% of patients, despite median use for three days, and early IABP discontinuation was required in only 2.1% of patients.
CONCLUSIONS: With contemporary advances in device technology, insertion technique, and operator experience, IABP counterpulsation may be successfully employed for a wide variety of conditions in the AMI setting, providing significant hemodynamic support with rare major complications in a high-risk patient population.
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Abbreviations and Acronyms
| | AMI | | acute myocardial infarction | | CABG | | coronary artery bypass grafting | | IABP | | intra-aortic balloon pump | | LMCA | | left main coronary artery | | SHOCK | | SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? |
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