The use of intraaortic balloon pumping as an adjunct to reperfusion therapy in acute myocardial infarction

Abstract

To assess the risk and possible benefits of use of the percutaneous IABP in patients given thrombolytic therapy as treatment for acute myocardial infarction, we prospectively evaluated 810 consecutive patients entered into the TAMI trials. During hospitalization the 85 patients treated with the IABP had more cardiac risk factors, were slightly older (58 vs 56 years), and more often had anterior infarction (62% vs 38%). At acute cardiac catheterization, patients treated with the IABP also had more multivessel coronary disease (67% vs 43%), more frequent TIMI grade 0 or 1 flow (44% vs 28%), lower global ejection fraction (40% vs 52%), and worse regional infarct (-3.2 vs -2.5 SD/chord) and noninfarct (-0.67 vs +0.36 SD/chord) zone function. Although mortality rates (32% vs 4%) and in-hospital complications were greater in patients treated with the IABP, a greater improvement in global (delta ejection fraction: +1.9% vs +0.7%) and noninfarct zone (delta SD/chord: +0.11 vs -0.09) left ventricular function was observed in patients treated with the IABP at 1-week follow-up angiography. In addition, no reinfarction or reocclusion of the infarct-related artery occurred while patients were being treated with the IABP. These results suggest that the IABP may have a specific role after thrombolytic therapy in treating patients at high risk for reocclusion or at high risk for hemodynamic deterioration because of large infarction or critical stenoses in coronary vessels supplying the noninfarct zone.

A randomized comparison of intra-aortic balloon pumping after primary coronary angioplasty in high risk patients with acute myocardial infarction

“…Despite this, mortality at the 6 month follow-up (13%) was not significantly higher and compares favourably to previous reports in similar patients, with mortality rates of 15% and 40% [8,14,17] . This low mortality might be attributed to the intra-aortic balloon pump, which has been shown to be of value in patients with cardiogenic shock [14] , but might also be related to the high rate of repeat revascularization within 6 months.…”

“…A number of other studies have addressed the value of intra-aortic balloon pumping in high risk infarct patients; no improvement in clinical outcome has consistently been found. Most of these studies were non-randomized [5][6][7][8] , however. Two randomized trials have been published.…”

“…Previous reports showed that intra-aortic balloon pumping after reperfusion therapy prevented reocclusion of the infarct vessel. However, it did not affect left ventricular function, and did not prevent haemodynamic deterioration [6][7][8] . We conducted a randomized trial to evaluate the systematic use of intra-aortic balloon pumping in high-risk myocardial infarct patients treated with primary coronary angioplasty.…”

Role of Intra-Aortic Counterpulsation in Cardiogenic Shock and Acute Myocardial Infarction

“…The studies suggest that IACP decreases the rate of coronary reocclusion and reinfarction after thrombolysis, PTCA or both interven tions combined. Among 810 patients of the TAMI studies undergoing routine acute heart catheterization after thrombolysis and if re quired PTCA, 85 patients received IACP [48]. The most striking finding of this study was the absence of reinfarction or reocclusion of the infarct artery during IACP compared to a rate of 13% in patients not receiving IACP.…”

Kreislaufunterstützung durch die intraaortale Ballongegenpulsation

“…Die IABP wird zunehmend als Unterstützung für Patienten mit hohem Risiko bei Koronarangiographie bzw. PTCA eingesetzt [41,42]. Die schleusenlose Insertion sowie zunehmende technische Verbesserungen der Steuersysteme machen eine einfache Handhabung im Katheterlabor möglich.…”