PDF icon Download PDF
Int J Angiol 2013; 22(04): 213-222
DOI: 10.1055/s-0033-1348884
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Use of Intra-aortic Balloon Pump in a Real-World Setting: A Comparison between Survivors and Nonsurvivors from Acute Coronary Syndrome Treated with IABP. The Jakarta Acute Coronary Syndrome Registry

Surya Dharma
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
,
Iwan Dakota
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
,
Isman Firdaus
1   Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
,
Alexander J. Wardeh
2   Department of Cardiology, M.C. Haaglanden, The Hague, The Netherlands
,
J. Wouter Jukema
3   Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations
Further Information

Publication History

Publication Date:
23 July 2013 (online)

   Permissions and Reprints
Preview

Abstract

Real-world data on acute coronary syndrome (ACS) patients who received intra-aortic balloon pump (IABP) support are limited. The objective of this study was to evaluate the characteristics of ACS patients who received IABP support from a real-world ACS registry. Patients with ACS (N = 121) who received IABP support were enrolled. Characteristics of survivors and nonsurvivors were compared at 30 days. Mortality rate of patients with ACS who received IABP was 47%. The survivors (N = 64) had less often cardiogenic shock (p < 0.001), more often IABP usage as back-up for a revascularization procedure (p = 0.002), less often resuscitation (p = 0.043), and less mechanical ventilator support (p < 0.001) than nonsurvivors. The nonsurvivors had a significantly higher leukocyte count (p = 0.033), a higher serum creatinine level (p < 0.001), a higher blood sugar on admission (p = 0.001), higher creatine kinase MB levels (p = 0.002), and a higher serum uric acid level (p < 0.001), but significantly lower left and right ventricular function (p = 0.014 and p = 0.003, respectively) than survivors. At 30 days, non-ST elevation (STE)-ACS patients had lower mortality rate than ST segment elevation myocardial infarction patients (log-rank test, p < 0.001), and non-STE-ACS patients who had not suffered from cardiogenic shock showed the lowest mortality rate (log-rank test, p < 0.001). By multivariate analysis, a heart rate ≥ 100 beats per minute before IABP insertion was the strongest predictor of 30-day mortality (hazard ratio = 5.69; 95% confidence interval, 1.49 to 21.78; p = 0.011). In ACS patients presenting with either cardiogenic shock, resuscitated, or patients who needed mechanical ventilation suffered from high mortality, despite the use of IABP. IABP appears to be safe and tended to be favorable in noncardiogenic shock ACS patients, particularly non-STE-ACS. A heart rate of ≥ 100 beats per minute prior to IABP insertion was the strongest predictor of 30-day mortality.

Keywords

IABP - ACS - survivor - nonsurvivor

Note

This is an original article and has not been submitted elsewhere.


 

  • References

  • 1 Kantrowitz A, Tjonneland S, Freed PS, Phillips SJ, Butner AN, Sherman Jr JL. Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA 1968; 203 (2) 113-118
    CrossrefPubMedSearch in Google Scholar
  • 2 Weber KT, Janicki JS. Intraaortic balloon counterpulsation. A review of physiological principles, clinical results, and device safety. Ann Thorac Surg 1974; 17 (6) 602-636
    CrossrefPubMedSearch in Google Scholar
  • 3 Scheidt S, Wilner G, Mueller H , et al. Intra-aortic balloon counterpulsation in cardiogenic shock. Report of a co-operative clinical trial. N Engl J Med 1973; 288 (19) 979-984
    CrossrefPubMedSearch in Google Scholar
  • 4 Antman EM, Anbe DT, Armstrong PW , et al; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; Canadian Cardiovascular Society. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation 2004; 110 (9) e82-e292
    PubMedSearch in Google Scholar
  • 5 Levine GN, Bates ER, Blankenship JC , et al; ACCF; AHA; SCAI. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2012; 79 (3) 453-495
    CrossrefPubMedSearch in Google Scholar
  • 6 Steg PG, James SK, Atar D , et al; Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33 (20) 2569-2619
    CrossrefPubMedSearch in Google Scholar
  • 7 Babaev A, Frederick PD, Pasta DJ, Every N, Sichrovsky T, Hochman JS. NRMI Investigators. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 2005; 294 (4) 448-454
    CrossrefPubMedSearch in Google Scholar
  • 8 Goldberg RJ, Samad NA, Yarzebski J, Gurwitz J, Bigelow C, Gore JM. Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med 1999; 340 (15) 1162-1168
    CrossrefPubMedSearch in Google Scholar
  • 9 Thiele H, Zeymer U, Neumann FJ , et al; IABP-SHOCK II Trial Investigators. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367 (14) 1287-1296
    CrossrefPubMedSearch in Google Scholar
  • 10 Forrester JS, Diamond G, Chatterjee K, Swan HJ. Medical therapy of acute myocardial infarction by application of hemodynamic subsets (second of two parts). N Engl J Med 1976; 295 (25) 1404-1413
    CrossrefPubMedSearch in Google Scholar
  • 11 Lang RM, Bierig M, Devereux RB , et al; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification. J Am Soc Echocardiogr 2005; 18 (12) 1440-1463
    CrossrefPubMedSearch in Google Scholar
  • 12 Bleeker GB, Steendijk P, Holman ER , et al. Assessing right ventricular function: the role of echocardiography and complementary technologies. Heart 2006; 92 (Suppl. 01) i19-i26
    CrossrefPubMedSearch in Google Scholar
  • 13 The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators. N Engl J Med 1993; 329 (10) 673-682
    CrossrefPubMedSearch in Google Scholar
  • 14 MONICA criteria: WHO Monica Project: MONICA manual. Part IV: Event registration. Available at: http://www.ktl.fi/publications/monica/manual/part4/iv-2.htm#s1-1
    PubMed
  • 15 Hirsch AT, Haskal ZJ, Hertzer NR , et al; American Association for Vascular Surgery; Society for Vascular Surgery; Society for Cardiovascular Angiography and Interventions; Society for Vascular Medicine and Biology; Society of Interventional Radiology; ACC/AHA Task Force on Practice Guidelines Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease; American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; Vascular Disease Foundation. ACC/AHA 2005 Practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). Circulation 2006; 113 (11) e463-e654
    CrossrefPubMedSearch in Google Scholar
  • 16 Ferguson III JJ, Cohen M, Freedman Jr RJ , et al. The current practice of intra-aortic balloon counterpulsation: results from the Benchmark Registry. J Am Coll Cardiol 2001; 38 (5) 1456-1462
    CrossrefPubMedSearch in Google Scholar
  • 17 Fotopoulos GD, Mason MJ, Walker S , et al. Stabilization of medically refractory ventricular arrhythmia by intra-aortic balloon counterpulsation. Heart 1999; 82 (1) 96-100
    PubMedSearch in Google Scholar
  • 18 Perera D, Stables R, Thomas M , et al; BCIS-1 Investigators. Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. JAMA 2010; 304 (8) 867-874
    CrossrefPubMedSearch in Google Scholar
  • 19 Rubino AS, Onorati F, Santarpino G , et al. Early intra-aortic balloon pumping following perioperative myocardial injury improves hospital and mid-term prognosis. Interact Cardiovasc Thorac Surg 2009; 8 (3) 310-315
    PubMedSearch in Google Scholar
  • 20 Cochran RP, Starkey TD, Panos AL, Kunzelman KS. Ambulatory intraaortic balloon pump use as bridge to heart transplant. Ann Thorac Surg 2002; 74 (3) 746-751 , discussion 751–752
    CrossrefPubMedSearch in Google Scholar
  • 21 The GISSI Investigators. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI). Lancet 1986; 1 (8478) 397-402
    PubMedSearch in Google Scholar
  • 22 Van de Werf F. The International Study Group. In-hospital mortality and clinical course of 20,891 patients with suspected acute myocardial infarction randomised between alteplase and streptokinase with or without heparin. Lancet 1990; 336 (8707) 71-75
    CrossrefPubMedSearch in Google Scholar
  • 23 Hochman JS, Boland J, Sleeper LA , et al; SHOCK Registry Investigators. Current spectrum of cardiogenic shock and effect of early revascularization on mortality. Results of an International Registry. Circulation 1995; 91 (3) 873-881
    CrossrefPubMedSearch in Google Scholar
  • 24 Goldberg RJ, Spencer FA, Gore JM, Lessard D, Yarzebski J. Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation 2009; 119 (9) 1211-1219
    CrossrefPubMedSearch in Google Scholar
  • 25 Alexander JH, Reynolds HR, Stebbins AL , et al; TRIUMPH Investigators. Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. JAMA 2007; 297 (15) 1657-1666
    CrossrefPubMedSearch in Google Scholar
  • 26 Gandhi GY, Roger VL, Bailey KR, Palumbo PJ, Ransom JE, Leibson CL. Temporal trends in prevalence of diabetes mellitus in a population-based cohort of incident myocardial infarction and impact of diabetes on survival. Mayo Clin Proc 2006; 81 (8) 1034-1040
    CrossrefPubMedSearch in Google Scholar
  • 27 Morrow DA, Antman EM, Charlesworth A , et al. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation 2000; 102 (17) 2031-2037
    CrossrefPubMedSearch in Google Scholar
  • 28 Granger CB, Goldberg RJ, Dabbous O , et al; Global Registry of Acute Coronary Events Investigators. Predictors of hospital mortality in the global registry of acute coronary events. Arch Intern Med 2003; 163 (19) 2345-2353
    CrossrefPubMedSearch in Google Scholar
  • 29 Sorajja P, Gersh BJ, Cox DA , et al. Impact of multivessel disease on reperfusion success and clinical outcomes in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Eur Heart J 2007; 28 (14) 1709-1716
    CrossrefPubMedSearch in Google Scholar
  • 30 Taylor GJ, Humphries JO, Mellits ED , et al. Predictors of clinical course, coronary anatomy and left ventricular function after recovery from acute myocardial infarction. Circulation 1980; 62 (5) 960-970
    CrossrefPubMedSearch in Google Scholar
  • 31 Singh BN. Increased heart rate as a risk factor for cardiovascular disease. Eur Heart J 2003; 5: G3-G9
    CrossrefPubMedSearch in Google Scholar
  • 32 Sjauw KD, Engström AE, Vis MM , et al. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?. Eur Heart J 2009; 30 (4) 459-468
    CrossrefPubMedSearch in Google Scholar