The effect of intraaortic balloon counterpulsation on regional myocardial blood flow and oxygen consumption in the presence of coronary artery stenosis in patients with unstable angina.

Williams, David O.; Korr, Kenneth S.; Gewirtz, Henry; Most, Albert S.

doi:10.1161/01.cir.66.3.593

Cited by 150 publications

(56 citation statements)

References 30 publications

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“…87 Although these favorable hemodynamic effects have demonstrated improvements in outcomes among patients with acute MI complicated by cardiogenic shock in some, 88 but not all studies, 89 early planned intra-aortic balloon counterpulsation use did not reduce myocardial infarct size measured by cardiac MRI among patients with anterior STEMI without cardiogenic shock. 90 Compared with intra-aortic balloon counterpulsation, Impella LP 2.5 may provide superior hemodynamic support and serve as a more effective bridge to recovery or transplantation, although experience in this setting is limited and further studies are needed.…”

Section: Percutaneous Mechanical Circulatory Supportmentioning

confidence: 99%

Reperfusion Strategies in Acute Coronary Syndromes

Bagai

Dangas

Stone

et al. 2014

Circulation Research

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The appropriate timing of angiography to facilitate revascularization is essential to optimize outcomes in patents with ST-segment–elevation myocardial infarction and non–ST-segment–elevation acute coronary syndromes. Timely reperfusion of the infarct-related coronary artery in ST-segment–elevation myocardial infarction both with fibrinolysis or percutaneous coronary intervention minimizes myocardial damage, reduces infarct size, and decreases morbidity and mortality. Primary percutaneous coronary intervention is the preferred reperfusion method if it can be performed in a timely manner. Strategies to reduce health system–related delays in reperfusion include regionalization of ST-segment–elevation myocardial infarction care, performing prehospital ECGs, prehospital activation of the catheterization laboratory, bypassing geographically closer nonpercutaneous coronary intervention–capable hospitals, bypassing the percutaneous coronary intervention–capable hospital emergency department, and early and consistent availability of the catheterization laboratory team. With implementation of such strategies, there has been significant improvement in process measures, including door-to-balloon time. However, despite reductions in door-to-balloon times, there has been little change during the past several years in in-hospital mortality, suggesting additional factors including patient-related delays, optimization of tissue-level perfusion, and cardioprotection must be addressed to improve patient outcomes further. Early angiography followed by revascularization when appropriate also reduces rates of death, MI, and recurrent ischemia in patients with non–ST-segment–elevation acute coronary syndromes, with the greatest benefits realized in the highest risk patients. Among patients with non–ST-segment–elevation acute coronary syndromes with multivessel disease, choice of revascularization modality should be made as in stable coronary artery disease, with a goal of complete ischemic revascularization.

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Section: Percutaneous Mechanical Circulatory Supportmentioning

confidence: 99%

Reperfusion Strategies in Acute Coronary Syndromes

Bagai

Dangas

Stone

et al. 2014

Circulation Research

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“…[10][11][12] The widespread use of IABP during high-risk PCI, acute myocardial infarction, and cardiogenic shock 13,14 had been at odds with the paucity of adequately powered randomized controlled trials in these settings. However, the past 2 years have seen publication of randomized trial data on the use of elective IABP support during high-risk PCI 3 and PCI for acute ST-segment elevation myocardial infarction, 15 and the results of the first randomized trial of IABP use in cardiogenic shock were presented earlier this year.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Mortality Data From the Balloon Pump–Assisted Coronary Intervention Study (BCIS-1)

et al. 2013

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I ntra-aortic balloon counterpulsation ameliorates ischemia by simultaneously augmenting coronary blood flow and reducing myocardial oxygen demand, making it a potentially valuable therapy for providing circulatory support in cardiogenic shock or preventing the occurrence of major complications during high-risk percutaneous coronary intervention (PCI). Singlecenter observational data had suggested a reduction in mortality and major complications with the use of an elective intra-aortic balloon pump (IABP) during high-risk PCI, 1,2 but the Balloon Pump-Assisted Coronary Intervention Study (BCIS-1) was the first randomized controlled evaluation of the safety and efficacy of counterpulsation during high-risk PCI.3 Compared with patients who had PCI without planned IABP support, those who received elective IABP insertion were found to have a similar incidence of major adverse cardiac and cerebrovascular events (MACCE) at hospital discharge, which is the primary outcome of the study. However, differences were observed in the major secondary outcomes of BCIS-1: the occurrence of procedural complications and all-cause mortality at 6 months. Procedural complications occurred much less frequently in patients who received elective IABP support, and fewer early deaths were noted in this group, although relatively few deaths had occurred at 6 months, and the difference in mortality was not statistically significant at that stage. Elective IABP use during high-risk PCI has a class IIb recommendation (level of evidence C) in the current American College of Cardiology Foundation/American Background-There is conflicting evidence on the utility of elective intra-aortic balloon pump (IABP) use during high-risk percutaneous coronary intervention (PCI). Observational series have indicated a reduction in major in-hospital adverse events, although randomized trial evidence does not support this. A recent study has suggested a mortality benefit trend early after PCI, but there are currently no long-term outcome data from randomized trials in this setting. Methods and Results-Three hundred one patients with left ventricular impairment (ejection fraction <30%) and severe coronary disease (BCIS-1 jeopardy score ≥8; maximum possible score=12) were randomized to receive PCI with elective IABP support (n=151) or without planned IABP support (n=150). Long-term all-cause mortality was assessed by tracking the databases held at the Office of National Statistics (in England and Wales) and the General Register Office (in Scotland). The groups were balanced in terms of baseline characteristics (left ventricular ejection fraction, 23.6%; BCIS-1 jeopardy score, 10.4) and the amount and type of revascularization performed. Mortality data were available for the entire cohort at a median of 51 months (interquartile range, 41-58) from randomization. All-cause mortality at follow-up was 33% in the overall cohort, with significantly fewer deaths occurring in the elective IABP group (n=42) than in the group that underwent PCI without planned IABP support ...

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“…When compared with intraaortic balloon pumping (IABP), the counter-pulse mode of the NHLCS has a more active effect on reducing LVEDP, so it may be considered to be more effective for enhancing CoF. 44, 48 On the other hand, in the co-pulse mode, CoF was reduced for the opposite reason. In fact, we have proved that LVEDP is reduced in the counter-pulse mode and enhanced in the co-pulse mode.…”

Section: Discussionmentioning

confidence: 99%

“…[43][44][45][46][47] A counter-pulse effect may be useful for increasing coronary perfusion with increasing aortic pressure in the diastolic phase. 44, [48][49][50] Therefore, in the present study we focused on CoF, which we expected to control with the cf-LVAD using the pulsatile driving technique. First, we noted that CoF increased in the time.…”

Section: Umeki a Et Almentioning

confidence: 99%