This randomized trial showed that careful use of prophylactic aortic counterpulsation can prevent reocclusion of the infarct-related artery and improve overall clinical outcome in patients undergoing acute cardiac catheterization during myocardial infarction.
OBJECTIVETo evaluate the effectiveness of prophylactic intra-aortic balloon (IAB) in elective myocardial revascularization surgery (MRS), to prevent trans or post-operative infarction and reduce intra-hospital mortality in patients with low left ventricular ejection fraction.
METHODUsing a cohort study model, 239 patients with left ventricular ejection fraction ≤40%, submitted to elective MRS with extracorporeal circulation (ECC) were evaluated from March 1995 to February 2001.
RESULTSOf these, 58 patients received preoperative IAB and the remainder underwent surgery without circulatory assistance (control group). The two groups of patients had similar characteristics regarding factors associated to the pertaining outcomes. There were fi ve demises (8.6%) in the group with IAB and 21 (11.6%) in the control group (non-signifi cant difference). There were 2 (3.4%) infarctions in the IAB group and 28 (15.5%) in the control group (p< 0.05), relative risk of 0.22 with an interval of confi dence of 95% from 0.05 to 0.85.
CONCLUSIONThe use of pre-operative IAB can signifi cantly reduce the risk of trans or post-operative acute myocardial infarction (AMI) in patients with decreased systolic function, without increasing vascular complications. In this same situation, the IAB does not signifi cantly decrease mortality. Randomized studies are necessary to establish more precise conclusions.
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