Intra-Aortic Balloon Pump for High-Risk Percutaneous Coronary Intervention

Abstract

Interestingly, the International Benchmark Registry (250 US and non-US centers) of over 20 000 patients treated with IABP suggested that 1 in 5 cases of IABP implantation were for CS and 1 in 5 as an adjunct to high-risk PCI. 11 In the context of AMI, IABP was used more frequently during CS (30%) or an adjunct to PCI (30%).10 Analysis of the CathPCI Registry from the National Cardiovascular Data Registry of patients who underwent high-risk PCI (10% in CS and 80% ST-segmentelevation myocardial infarction [STEMI]) with and without the use of IABP found IABP use was slightly less-10% of (Circ Cardiovasc Interv. 2014;7:712-720.) © 2014 American Heart Association, Inc. Post-MI and Cardiogenic ShockAMI is complicated by CS in ≈5% to 10% of cases. Although death from AMI has decreased with aggressive primary prevention and after wide-scale institution of early urgent revascularization, the incidence of CS after MI remains unchanged. 25The presence of CS is a major adverse prognostic factor and still the most common cause of hospital mortality (60%-70%) associated with AMI. 26 In addition to revascularization, optimal drug therapy, vasopressor, and inotropic support, IABP is the most commonly used mechanical support device to maintain hemodynamic stability in an attempt to improve clinical outcome. The evidence for the use of IABP as an adjunct to PCI in post-MI CS is controversial. A recent meta-analysis of registry data showed no benefit from the use of IABP in CS with regard to 30-day mortality independent of reperfusion strategy, which led to the recent downgrading of the American Heart Association guidelines on hemodynamic support in post-MI CS from a Class I recommendation to Class IIB. [27][28][29] Early use of IABP in post-MI CS was based predominantly on small nonrandomized retrospective studies. In the thrombolytic era, concomitant IABP in the presence of recombinant-tissue plasminogen activator was thought to enhance thrombolysis through augmentation of perfusion pressure and was associated with a reduction in in-hospital and 1-year mortality when compared with thrombolysis alone. 30,31 In the late 1990s, the multicenter randomized Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial showed a benefit to short-, medium-, and longterm survival incurred by early revascularization post-MI complicated by CS. 32 The Thrombolysis and Counterpulsation to Improve Survival in Myocardial Infarction Complicated by Hypotension and Suspected Cardiogenic Shock (TACTICS) randomized trial of IABP-assisted thrombolysis in post-MI CS did not reach its primary end point of improved 6-month survival, but there was trend to increased survival with IABP in patients with significant heart failure. 33 One interpretation is that thrombolysis is an inferior reperfusion strategy, and this may explain why no benefit has been definitively shown with IABP after primary PCI. A meta-analysis of IABP use in patients with AMI showed no effect on outcome; however, in the subset of AMI and CS, there was si...

Abdominal aortic peripheral intervention to facilitate intra-aortic balloon pump support during high risk percutaneous coronary intervention: a case report

“…No significant differences in the 30-day mortality and secondary outcomes were found. Although the timing, clinical scenarios and conditions which IABP demonstrates its beneficial effects remain unclear and despite the randomized controlled trial data suggesting no IABP-supported revascularization in post-myocardial infarction cardiogenic shock patients, the IABP insertion should still be tailored to the clinical condition of the patient and the caution of the operating physician [ 16 ].…”

The role of mechanical support devices during percutaneous coronary intervention

“…The intra-aortic balloon pump (IABP) was introduced into clinical practice in 1968 and remains the most widely used percutaneous MCS, due to availability and ease of insertion. 12 The device is usually inserted via the femoral artery, although the axillary, brachial and iliac routes have also been successfully used. The distal end of device is positioned retrogradely, 2-3 cm distal to left subclavian artery at the level of carina.…”

Intra-aortic Balloon Pump—Current Status

“…However, evidence for this recommendation was mainly based on data from registry. 12 In a randomized, prospective, open-labeled multicenter trial (Should we emergently revascularise Occluded Coronaries for cardiogenic shock [SHOCK] II trial), a total of 600 patients with cardiogenic shock complicating acute myocardial infarction (MI) were assigned to IABP or no IABP; 300 patients in the IABP group and 298 in the control group were included in the analysis of the primary endpoint that was defined as 30-day all-cause mortality. 13 At 30 days, 119 (39.7%) patients in the IABP group and 123 (41.3%) patients in the control group had died.…”