Effect of Intraaortic Balloon Pumping on Left Ventricular Function in Patients With Persistent ST Segment Elevation After Revascularization for Acute Myocardial Infarction.

Abstract

n acute myocardial infarction (AMI), early, complete and sustained restoration of blood flow in the occluded coronary artery can salvage myocardium at risk and improve survival. 1 Revascularization of the occluded coronary artery with balloon angioplasty can be achieved in >90% of patients. 2 However, even early restoration of thrombolysis-in-myocardial-infarction (TIMI) grade 3 flow is not always associated with myocardial reperfusion because of microvascular damage. [3][4][5][6][7] Recent studies have demonstrated that persistent ST segment elevation after revascularization is a marker of impaired microvascular reperfusion 8 and is associated with a worse clinical outcome. [9][10][11][12] Intraaortic balloon pumping (IABP), which can reduce the rate of infarct-related artery reocclusion, augment myocardial recovery and improve clinical outcome after AMI, 13,14 would be expected to be most effective in AMI patients with persistent ST segment elevation after revascularization.This study was undertaken to assess the impact of IABP on left ventricular function in AMI patients with persistent ST segment elevation after revascularization. Methods Study PopulationBetween January ented with a first anterior AMI and underwent emergency coronary angiography within 6 h of the onset of chest pain. The data relating to these patients were prospectively entered into a computer database, and from this we selected 51 patients who met the following criteria: (1) ischemic chest pain lasting for >30 min; (2) ST segment elevation of at least 0.2 mV in 2 or more contiguous electrocardiographic (ECG) leads; (3) elevation of serum creatine kinase concentration to more than twice the normal upper limit; (4) total occlusion (TIMI grade 0 or 1) of the proximal left The purpose of the present study was to assess the impact of intraaortic balloon pumping (IABP) in patients with persistent ST elevation who underwent revascularization within 6 h of their first acute anterior myocardial infarction (AMI). Persistent ST elevation after revascularization was defined as being ≥50% of the initial value on return to the coronary care unit. Twenty-four patients were treated without IABP (control group) and 27 patients were treated with IABP (IABP group). There was no significant difference between the 2 groups in pretreatment left ventricular ejection fraction (LVEF), end-diastolic volume index or end-systolic volume index. After 137±46 days, the change in the LVEF was significantly higher in the IABP group than in the control group (5±13% vs 13±15%, p=0.04). However, the left ventricular end-diastolic volume index was similar between the 2 groups during follow-up (pretreatment: 77±19 ml/m 2 vs 74±13 ml/m 2 , p=0.54; follow-up: 86±22 ml/m 2 vs 83±18 ml/m 2 , p=0.60). These data suggest that IABP enhances the improvement in LVEF independent of remodeling in AMI patients with persistent ST elevation after revascularization.

Predictive Factors of Major Adverse Cardiac Events in Acute Myocardial Infarction Patients Complicated by Cardiogenic Shock Undergoing Primary Percutaneous Coronary Intervention

“…Kurisu et al reported that IABP was effective in patients with persistent ST elevation after PCI for AMI. 40 …”

Right bundle-branch block in anterior acute myocardial infarction in the coronary intervention era: Acute angiographic findings and prognosis

“…On the contrary, it is known that the salutary effect of β-blockers is greatest in high-risk patients. Patients with anterior AMI and RBBB should be recognized early and receive prompt and aggressive treatment such as β-blockers [25] or intraaortic balloon pumping [26].…”

Impact of the Magnitude of the Initial ST-Segment Elevation on Left Ventricular Function in Patients With Anterior Acute Myocardial Infarction

“…Because we could not perform myocardial contrast echocardiography routinely, a precise correlation between initial ST-segment magnitude and the no-reflow phenomenon remains unclear. However, this study indicates the need for adjunctive pharmacological [19][20][21][22] or mechanical therapy 23 to improve myocardial perfusion, especially in patients with total occlusion and ∑ST ≥10 mm. In addition, in patients with ∑ST <10 mm, reperfusion therapy increased ∑ST slightly but significantly.…”