The outcome of intra-aortic balloon pump support in acute myocardial infarction complicated by cardiogenic shock according to the type of revascularization: A comprehensive meta-analysis

Romeo, Francesco; Acconcia, Maria Cristina; Sergi, Domenico; Romeo, Alessia; Muscoli, Saverio; Valente, Serafina; Gensini, Gian Franco; Chiarotti, Flavia; Caretta, Quintilio

doi:10.1016/j.ahj.2013.02.020

Cited by 50 publications

(41 citation statements)

References 40 publications

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“…However, among patients who received primary PCI, a 6 % increase in 30-day mortality was observed (p= 0.0008). Similar findings were described in another recent meta-analysis by Romeo et al [13]. [50].…”

Section: Ami With Cssupporting

confidence: 82%

Use of Left Ventricular Support Devices During Acute Coronary Syndrome and Percutaneous Coronary Intervention

Spiro

Doshi

2014

Curr Cardiol Rep

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In an effort to improve outcomes in percutaneous coronary intervention (PCI), percutaneous ventricular assist devices (PVADs) have been investigated in (1) high-risk PCI, (2) acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) and (3) in AMI without CS. PCI has become an increasing complex due to an ageing population with complex disease and the frequent presence of impaired LV function. Patients undergoing high-risk PCI in these circumstances are prone to acute cardiovascular collapse. Additionally, mortality in AMI complicated by CS remains high. Lastly, LV support during AMI may reduce infarct size and therefore preserve LV function. At present, four commercially available devices exist: intra-aortic balloon pump counterpulsation (IABP), Impella, TandemHeart and extracorporeal membrane oxygenation (ECMO). These devices are employed in an effort to increase cardiac output, mean arterial pressure (MAP) and coronary perfusion and to reduce pulmonary capillary wedge pressure (PCWP). The mechanism of action differs with each device, and there are advantages and disadvantages. In this update, we discuss recent data describing the use of PVADs to support patients with AMI with or without cardiogenic shock and during high-risk PCI. We focus on the unique features of each device, highlighting strengths, weaknesses and frequently encountered complications, which may be important when tailoring the most appropriate PVAD therapy to an individual patient's need.

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Section: Ami With Cssupporting

confidence: 82%

Use of Left Ventricular Support Devices During Acute Coronary Syndrome and Percutaneous Coronary Intervention

Spiro

Doshi

2014

Curr Cardiol Rep

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“…A previous meta-analysis of 10,529 patients, however, supported IABP therapy adjunctive to thombolysis, but did not support IABP therapy adjunctive to primary PCI [4]. Another recent meta-analysis including IABP SHOCK II trial showed that IABP support is effective in thrombolytic therapy reperfusion but is associated with a significant increase of in-hospital mortality with pPCI [36]. Thiele et al also analyzed, in a subsequent study, a 12-month follow-up of the patients enrolled in the IABP SHOCK II trial.…”

Section: Complications Of Iabp Insertionmentioning

confidence: 94%

Aortic counterpulsation in cardiogenic shock during acute myocardial infarction

Rognoni¹,

Cavallino²,

Lupi³

et al. 2014

Expert Review of Cardiovascular Therapy

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Intra-aortic balloon counterpulsation is the most widely used form of mechanical hemodynamic support in the setting of cardiogenic shock due to ST-segment elevation myocardial infarction (STEMI). Intra-aortic balloon pump (IABP) is also strongly recommended (class 1b) in the current European guidelines for treatment of STEMI. The evidence of a possible benefit of IABP in this setting is based mainly on registry data and a few randomized trials. Cardiogenic shock and subsequent death due to STEMI result from three factors: hemodynamic deterioration, occurrence of multiorgan dysfunction and systemic inflammatory response. IABP does not cause an immediate improvement in blood pressure, but the recent SHOCK II trial shows positive effects on multiorgan dysfunction. Some experimental and clinical studies have indicated that IABP results in hemodynamic benefits as a result of afterload reduction and diastolic augmentation with improvement of coronary perfusion. However, the effect on cardiac output is modest and may not be sufficient to reduce mortality. Furthermore we can say that the use of IABP before coronary revascularization in the setting of STEMI complicated with cardiogenic shock may make the interventional procedure safer by improving left ventricular unloading. The purpose of the present review is to clarify the state of the art on this topic.

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“…Initial registry studies and retrospective analyses of randomised trial data suggested a possible mortality benefit from IABP use in patients receiving thrombolysis as a means of reperfusion. In contrast, patients undergoing PCI who received IABP support appeared to have increased mortality [23][24][25][26]. The only prospective, randomised study to assess the role of the IABP in CS in patients receiving thrombolysis for MI was the TACTICS study [27].…”

Section: Cardiogenic Shockmentioning

confidence: 98%