Role of Prophylactic Intra-Aortic Balloon Pump in High-Risk Patients Undergoing Percutaneous Coronary Intervention

Mishra, Sundeep; Chu, William W.; Torguson, Rebecca; Wolfram, Roswitha; Deible, Regina; Suddath, William O.; Pichard, Augusto D.; Satler, Lowell F.; Kent, Kenneth M.; Waksman, Ron

doi:10.1016/j.amjcard.2006.03.036

Cited by 112 publications

(58 citation statements)

References 24 publications

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“…The study was powered assuming a 30-day MAE rate of 30% in the IABP arm and a relative Impella treatment effect of 33%, resulting in a 30-day MAE rate of 20% in the Impella 2.5 arm, based on the prevalence of events in previous observational IABP studies 4,5 and the PROTECT I feasibility trial. 12 Accounting for 10% missing data, a total of 654 patients (327 per arm) were necessary to detect this treatment effect difference between Impella 2.5 and IABP at 80% power and a 2-sided ␣-error of 5%.…”

Section: Statistical Analysesmentioning

confidence: 99%

A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention

et al. 2012

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Background— Although coronary artery bypass grafting is generally preferred in symptomatic patients with severe, complex multivessel, or left main disease, some patients present with clinical features that make coronary artery bypass grafting clinically unattractive. Percutaneous coronary intervention with hemodynamic support may be feasible for these patients. Currently, there is no systematic comparative evaluation of hemodynamic support devices for this indication. Methods and Results— We randomly assigned 452 symptomatic patients with complex 3-vessel disease or unprotected left main coronary artery disease and severely depressed left ventricular function to intra-aortic balloon pump (IABP) (n=226) or Impella 2.5 (n=226) support during nonemergent high-risk percutaneous coronary intervention. The primary end point was the 30-day incidence of major adverse events. A 90-day follow-up was required, as well, by protocol. Impella 2.5 provided superior hemodynamic support in comparison with IABP, with maximal decrease in cardiac power output from baseline of −0.04±0.24 W in comparison with −0.14±0.27 W for IABP ( P =0.001). The primary end point (30-day major adverse events) was not statistically different between groups: 35.1% for Impella 2.5 versus 40.1% for IABP, P =0.227 in the intent-to-treat population and 34.3% versus 42.2%, P =0.092 in the per protocol population. At 90 days, a strong trend toward decreased major adverse events was observed in Impella 2.5–supported patients in comparison with IABP: 40.6% versus 49.3%, P =0.066 in the intent-to-treat population and 40.0% versus 51.0%, P =0.023 in the per protocol population, respectively. Conclusions— The 30-day incidence of major adverse events was not different for patients with IABP or Impella 2.5 hemodynamic support. However, trends for improved outcomes were observed for Impella 2.5–supported patients at 90 days. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00562016.

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Section: Statistical Analysesmentioning

confidence: 99%

A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention

et al. 2012

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“…IABP (Arrow Corp., USA) was initiated in the cardiac catheterization laboratory, immediately before PCI [7]. IABP was continued after PCI and patients were observed in the coronary care unit.…”

Section: Methodsmentioning

confidence: 99%

Intra-Aortic Balloon Pump Improves Clinical Prognosis and Attenuates C-Reactive Protein Level in Acute STEMI Complicated by Cardiogenic Shock

Xiao

et al. 2010

Cardiology

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Objectives: Intra-aortic balloon pump (IABP) plays a pivotal role in the treatment of cardiogenic shock (CS) complicating acute ST-segment elevation myocardial infarction (STEMI). However, the influence of IABP on the inflammatory response has not been well evaluated. We sought to assess the effects of IABP support upon C-reactive protein (CRP) levels in patients with STEMI complicated by CS undergoing percutaneous coronary intervention (PCI). Methods: This was a prospective study and a total of 91 patients with STEMI complicated by CS receiving emergency PCI were enrolled, 43 cases of which received IABP support, and the remaining cases without IABP therapy were the control group. CRP levels were determined at admission, and on days 3 and 7. Troponin I peak, left ventricular function and major adverse cardiovascular events were compared following PCI. Results: The IABP group had lower CRP levels at days 3 and 7, greater improvement in left ventricular function and lower troponin peak following PCI. Significant differences were also observed in the incidence of mortality at 6-month follow-up, both in hospital and after 30 days. Conclusions: IABP support improves clinical prognosis and attenuates the CRP level in patients with CS complicating STEMI after PCI.

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“…While single CTO may be Bfair game^for any interventional cardiologist, if there are CTOs in more than one major artery it should remain in the domain of cardiac surgeon not only because of lower efficacy and higher complication rates associated with PCI but also higher cost entailed. Sole surviving artery and very low ejection fraction are other areas with higher risk of PCI unless a suitable cardiac assist device is prophylactically used (limited by higher cost and availability), here again CABG may be the most practical and safe option [9].…”

Section: Other Complex Lesionsmentioning

confidence: 99%

The shifting sands of coronary practice: from cardiologist’s amusement to a surgeon’s avocation

Mishra

2017

Indian J Thorac Cardiovasc Surg

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The field of coronary artery disease therapy has evolved over a period of time from medical therapy to coronary bypass surgery to interventional cardiology. However, none of the therapies have become obsolete and there is still place for optimal medical therapy, cardiac surgery as percutaneous interventions. The need of the hour is to develop an integrated multi-disciplinary approach popularly known as heart team approach at least for complex situations whether patient or lesion related.

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Role of Prophylactic Intra-Aortic Balloon Pump in High-Risk Patients Undergoing Percutaneous Coronary Intervention

Cited by 112 publications

References 24 publications

A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention

A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention

Intra-Aortic Balloon Pump Improves Clinical Prognosis and Attenuates C-Reactive Protein Level in Acute STEMI Complicated by Cardiogenic Shock

The shifting sands of coronary practice: from cardiologist’s amusement to a surgeon’s avocation

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