Thrombolysis Plus Aortic Counterpulsation: Improved Survival in Patients Who Present to Community Hospitals With Cardiogenic Shock

Kovack, Paul J.; Rasak, Mark; Bates, Eric R.; Ohman, E. Magnus; Stomel, Robert J.

doi:10.1016/s0735-1097(97)82537-5

Cited by 132 publications

(58 citation statements)

References 23 publications

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“…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.…”

Section: Routine Vs Elective Use Of Intra-aortic Balloon Pumpsupporting

confidence: 84%

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

Hof

1999

European Heart Journal

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Aims Intra-aortic balloon pumping reduces afterload and may be effective in improving reperfusion in high risk infarct patients treated with primary angioplasty.Methods High risk infarct patients referred from other centres for primary PTCA were randomized to treatment with or without an intra-aortic balloon pump. The primary end-point consisted of the combination of death, non-fatal reinfarction, stroke or an ejection fraction <30% at the 6 month follow-up. A weighted unsatisfactory outcome score (as previously described by Braunwald), enzymatic infarct size and left ventricular ejection fraction were secondary end-points.Results During a 3·5 year period, 238 patients were randomized, 118 to intra-aortic balloon pump therapy and 120 to no intra-aortic balloon pump therapy. Cross-over (25% in the intra-aortic balloon pump group and 31% in the no-intra-aortic balloon pump group) occurred in both treatment arms. The primary end-point was reached in 31 (26%) patients assigned to an intra-aortic balloon pump and in 31 (26%) assigned to no intra-aortic balloon pump (P=0·94). Enzymatic infarct size (LDHQ 72 ) was calculated in 163 (68%) patients and was not significantly different between either group (intra-aortic balloon pump: 1616 1148, no intra-aortic balloon pump: 1608 1163). The left ventricular ejection fraction was measured at the 6 month follow-up in 168 patients (80% of patients alive). No difference in ejection fraction was found in either group (intra-aortic balloon pump: 42 13%, no intra-aortic balloon pump: 40 14%, P=0·51). Major complications occurred in 8% of patients treated with an intra-aortic balloon pump.Conclusion Systematic use of intra-aortic balloon pumping after primary angioplasty does not lead to myocardial salvage or to a better clinical outcome in high-risk infarct patients. Use of intra-aortic balloon pumping after primary PTCA for acute myocardial infarction should be reserved for patients with severe haemodynamic compromise. (Eur Heart J 1999; 20: 659-665)

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Section: Routine Vs Elective Use Of Intra-aortic Balloon Pumpsupporting

confidence: 84%

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

Hof

1999

European Heart Journal

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“…Barron et al illustrated that patients with AMI complicated by CS may have substantial benefit from IABP when used in combination with thrombolysis, which decreased the odds of death by 18% [2]. Another 2 trials also showed that thrombolysis plus IABP could improve survival in these patients [11,12]. Similar to previous research, although there was a trend towards a few cases of bleeding and vascular complications, our present study showed that IABP therapy could attenuate the death rate markedly in these patients.…”

Section: Discussionmentioning

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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“…[11][12][13][14][15][16][17] Multiple studies have suggested mortality benefits of IABP in patients with cardiogenic shock complicating AMI. 3,7,8,20,21 The American College of Cardiology (ACC) and the American Heart Association (AHA) recommend the use of IABP in patients with shock refractory to pharmacological therapy and as a stabilizing measure for urgent revascularization. 22 Nevertheless, the use of IABP in the treatment of cardiogenic shock remains remarkably low.…”

Section: Discussionmentioning

confidence: 99%

Relation Between Hospital Intra-Aortic Balloon Counterpulsation Volume and Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock

et al. 2003

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Background-Increasing evidence suggests an inverse relationship between outcome and the total number of invasive cardiac procedures performed at a given hospital. The purpose of the present study was to determine if a similar relationship exists between the number of intra-aortic balloon counterpulsation (IABP) procedures performed at a given hospital per year and the in-hospital mortality rate of patients with acute myocardial infarction complicated by cardiogenic shock. Methods and Results-We

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Thrombolysis Plus Aortic Counterpulsation: Improved Survival in Patients Who Present to Community Hospitals With Cardiogenic Shock

Abstract: Survival may be enhanced and transfer for revascularization facilitated when community hospitals use both thrombolysis and IABP to treat patients with acute MI complicated by cardiogenic shock.

Cited by 132 publications

References 23 publications

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

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

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

Relation Between Hospital Intra-Aortic Balloon Counterpulsation Volume and Mortality in Acute Myocardial Infarction Complicated by Cardiogenic Shock

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