Intra-aortic balloon counterpulsation in acute myocardial infarction: old and emerging indications
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ORIGINAL ARTICLE
Intra-aortic balloon counterpulsation in acute myocardial infarction: old and emerging indications L. X. van Nunen & M. van ’t Veer & S. Schampaert & B. J. E. M. Steerneman & M. C. M. Rutten & F. N. van de Vosse & N. H. J. Pijls
Published online: 30 October 2013 # The Author(s) 2013. This article is published with open access at Springerlink.com
Abstract Background Recent evidence questions the role of intra-aortic balloon counterpulsation (IABP) in the treatment of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). An area of increasing interest is the use of IABP for persistent ischaemia (PI). We analysed the use of IABP in patients with AMI complicated by CS or PI. Methods From 2008 to 2010, a total of 4076 patients were admitted to our hospital for primary percutaneous coronary intervention (PCI) for AMI. Out of those, 239 patients received an IABP either because of CS or because of PI. Characteristics and outcome of those patients are investigated. Results The mean age of the study population was 64± 11 years; 75 % were male patients. Of the patients, 63 % had CS and 37 % had PI. Patients with CS had a 30-day mortality rate of 36 %; 1-year mortality was 41 %. Patients with PI had a 30-day mortality rate of 7 %; 1-year mortality was 11 %. Conclusions Mortality in patients admitted for primary PCI because of AMI complicated by CS is high despite IABP use. Outcome in patients treated with IABP for PI is favourable and mandates further prospective studies.
L. X. van Nunen : M. van ’t Veer : B. J. E. M. Steerneman : N. H. J. Pijls Department of Cardiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands L. X. van Nunen : M. van ’t Veer : B. J. E. M. Steerneman : N. H. J. Pijls (*) PO Box 1350, 5602 ZA Eindhoven, the Netherlands e-mail: [email protected] S. Schampaert : M. C. M. Rutten : F. N. van de Vosse Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600 MB Eindhoven, the Netherlands
Keywords Intra-aortic balloon counterpulsation . Cardiogenic shock . Persistent ischaemia . Acute myocardial infarction
Introduction Acute myocardial infarction (AMI) is complicated by cardiogenic shock (CS) in approximately 5–10 % of patients [1, 2]. Intra-aortic balloon counterpulsation (IABP) has been used as a haemodynamic support system for patients with AMI complicated by CS since 1968 [3]. Treatment with IABP is supposed to increase cardiac output by more effective emptying of the left ventricle, decreasing workload and thereby oxygen demand of the heart, and to reduce myocardial ischaemia by augmentation of coronary perfusion [4, 5]. Evidence for IABP use in patients with AMI complicated by CS is largely based upon pathophysiological considerations and non-randomised, small trials of patients treated with thrombolytic therapy [6]. However, the most recent large randomised trial on the use of IABP in patients with AMI complicated by CS showed no benefit on 30-day mortality [7]. As a result, the efficacy
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