Concomitant Use of Intraaortic Balloon Counterpulsation and Streptokinase in Acute Anterior Myocardial Infarction

Abstract

Using a prospective, nonrandomized design, the authors sought to determine whether concomitant use of intraaortic balloon counterpulsation (IABP) and streptokinase in acute anterior myocardial infarction (MI) would improve the in-hospital mortality rate and angiographic findings. The study included 45 patients with an acute anterior MI. All patients received intravenous streptokinase. Among these, 25 patients had concomitant IABP while the remaining 20 patients had streptokinase alone. All patients underwent cardiac catheterization. Patients treated with concomitant IABP had a significantly higher frequency of thrombolysis in myocardial infarction (TIMI) grade 3 flow (n: 11; 44% vs n: 1; 5%, p<0.05), and there was a trend toward a lower in-hospital mortality rate in the IABP group (n: 0; 0% vs n: 3; 15%, p=0.08). The angiographic presence of thrombus image and grade > or =2 coronary collateral circulation to the infarct-related coronary artery for the IABP and non-IABP groups did not differ significantly. The preliminary results of this study suggest that concomitant use of IABP and streptokinase in acute anterior MI increases the incidence of TIMI grade 3 flow and may have decreased the in-hospital mortality rate without unacceptable rates of vascular or hemorrhagic complications.

Mechanical Assistance by Intra‐Aortic Balloon Pump Counterpulsation During Reperfusion Increases Coronary Blood Flow and Mitigates the No‐Reflow Phenomenon: An Experimental Study

“…Previous clinical studies, using a Doppler‐tipped angioplasty guide wire, observed a significant increase in CBF by IABP (i) after successful coronary angioplasty in patients with severe coronary artery disease (33), (ii) after primary coronary angioplasty for acute MI (34), and (iii) in hemodynamically unstable patients (35,36). Furthermore, in patients presenting with MI and cardiogenic shock, IABP combined with myocardial revascularization increased TIMI flow (37), improved left ventricular function (38) and lowered mortality (8,14,18). However, in a previous clinical trial by Prondzinsky et al.…”

Cardiovascular Outcomes Using Intra-Aortic Balloon Pump in High-Risk Acute Myocardial Infarction With or Without Cardiogenic Shock

“…Intra-aortic balloon pump was found to significantly increase the risk of moderate bleeding (RR: 1.71; CI: 1.03-2.85; P ¼ .04; Figure 7 upper panel) [14][15][16][17]23,27 and major bleeding (RR: 4.01; CI: 2.66-6.06; P < .0001; Figure 8 upper panel). [14][15][16]22,23,27 When analysis was performed using only randomized controlled trials, 14 …”

“…After applying inclusion and exclusion criteria, 16 articles remained eligible for meta-analysis, of which 13 were prospective studies and 3 were retrospective studies. [13][14][15][16][17][18][19][20][22][23][24][25][26][27][28][29] Eight studies were excluded because no control arm was available, 30 no mortality data were available, [31][32][33][34] or there was different timing of outcomes. [35][36][37] Thus, the systematic literature search for studies comparing the effects of IABP with no IABP in patients with AMI, with or without cardiogenic shock using aforementioned criteria revealed a total of 16 studies (N ¼ 11 778).…”

“…Seven trials [14][15][16][17]22,23,27 provided data on moderate and major bleeding complications with IABP. The overall risk of moderate and major bleeding was found to be elevated when IABP was used (Figures 7 and 8).…”

Kreislaufunterstützung durch die intraaortale Ballongegenpulsation

“…Myokardinfarkt im Rahmen einer Katheterintervention eingesetzt [41,42]. Für den kombinierten Einsatz von katheterinterventionellen Verfahren mit der IABP konnte eine Senkung der Letalität beim akuten Myokardinfarkt nachgewiesen werden; auch für die kombinierte Anwendung mit der ᭤Thrombolyse konnte dieser Effekt gezeigt werden [3,22,32,33,34,44].…”