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Efficacy and timing of intra-aortic counterpulsation in patients with ST-elevation myocardial infarction complicated by cardiogenic shock

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Abstract

Background

Guidelines strongly recommend additional intra-aortic balloon pump (IABP) therapy in STEMI patients with cardiogenic shock (CS) treated by primary percutaneous coronary intervention (PCI). However, there is no randomised evidence suggesting survival benefit of IABP treatment in CS. It is suggested that timing of initiation of IABP therapy could be of great importance. Therefore, we compared mortality rates of IABP therapy versus no IABP therapy in the setting of STEMI complicated by CS. In addition, we investigated the effect of initiation of IABP therapy on mortality.

Methods

From a cohort of 292 STEMI patients with CS treated by primary PCI, 199 patients received IABP therapy (IABP group) and 93 patients received no support (no IABP group). The IABP group was divided into two subgroups based on timing of initiation of support, i.e. ‘IABP pre PCI’ (n = 59) and ‘IABP post PCI’ (n = 140). Outcomes were assessed by propensity stratification and multivariate logistic regression.

Results

All-cause 30-day mortality for the IABP versus the no IABP group was 47 % vs. 28 %, respectively, in univariate analysis resulting in an odds ratio (OR) of 1.67 (95%CI, 1.16 to 2.39). However, analyses adjusting outcomes by propensity stratification and logistic regression, respectively, neutralised this OR. In the IABP pre-PCI group vs. the post-PCI group 30-day mortality was 64 % vs. 40 %, resulting in an OR of 1.56 (95 % CI, 1.18 to 2.08). However, after propensity stratification analysis and multivariate logistic regression analysis, there were no significant differences in odds of 30-day mortality.

Conclusion

In our cohort of patients with STEMI complicated by CS treated with primary PCI we observed a difference in mortality between those treated with IABP and those treated without IABP in favour of the ‘no IABP’ group. The mortality difference was eliminated after adjustment for differences in case mix by propensity stratification or by logistic regression analysis. Neither did we observe any difference in mortality between patients whose IABP treatment was initiated before or immediately after PCI.

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References

  1. Babaev A, Frederick PD, Pasta DJ, et al. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2005;294:448–54.

    Article  PubMed  CAS  Google Scholar 

  2. Goldberg RJ, Spencer FA, Gore JM, et al. 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;119:1211–9.

    Article  PubMed  Google Scholar 

  3. Hochman JS. Cardiogenic shock complicating acute myocardial infarction: expanding the paradigm. Circulation. 2003;107:2998–3002.

    Article  PubMed  Google Scholar 

  4. Alexander JH, Reynolds HR, Stebbins AL, et al. Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. JAMA. 2007;297:1657–66.

    Article  PubMed  CAS  Google Scholar 

  5. Sjauw KD, Engstrom AE, Henriques JP. Percutaneous mechanical cardiac assist in myocardial infarction. Where are we now, where are we going? Acute Card Care. 2007;9(4):222–30.

    Article  PubMed  Google Scholar 

  6. Thiele H, Smalling RW, Schuler GC. Percutaneous left ventricular assist devices in acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2007;28:2057–63.

    Article  PubMed  Google Scholar 

  7. Abdel-Wahab M, Saad M, Kynast J, et al. Comparison of hospital mortality with intra-aortic balloon counterpulsation insertion before versus after primary percutaneous coronary intervention for cardiogenic shock complicating acute myocardial infarction. Am J Cardiol. 2010;105:967–71.

    Article  PubMed  Google Scholar 

  8. Cheng JM, den Uil CA, Hoeks SE, et al. Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J. 2009;30:2102–8.

    Article  PubMed  Google Scholar 

  9. Prondzinsky R, Lemm H, Swyter M, et al. Intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP SHOCK Trial for attenuation of multiorgan dysfunction syndrome. Crit Care Med. 2010;38:152–60.

    Article  PubMed  CAS  Google Scholar 

  10. Sjauw KD, Engstrom 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;30:459–68.

    Article  PubMed  Google Scholar 

  11. Vis MM, Sjauw KD, van der Schaaf RJ, et al. In patients with ST-segment elevation myocardial infarction with cardiogenic shock treated with percutaneous coronary intervention, admission glucose level is a strong independent predictor for 1-year mortality in patients without a prior diagnosis of diabetes. Am Heart J. 2007;154:1184–90.

    Article  PubMed  Google Scholar 

  12. Vis MM, Sjauw KD, van der Schaaf RJ, et al. Prognostic value of admission hemoglobin levels in ST-segment elevation myocardial infarction patients presenting with cardiogenic shock. Am J Cardiol. 2007;99:1201–2.

    Article  PubMed  CAS  Google Scholar 

  13. van der Schaaf RJ, Claessen BE, Vis MM, et al. Effect of multivessel coronary disease with or without concurrent chronic total occlusion on one-year mortality in patients treated with primary percutaneous coronary intervention for cardiogenic shock. Am J Cardiol. 2010;105:955–9.

    Article  PubMed  Google Scholar 

  14. Hochman JS, Boland J, Sleeper LA, et al. Current spectrum of cardiogenic shock and effect of early revascularization on mortality. Results of an International Registry. SHOCK Registry Investigators. Circulation. 1995;91:873–81.

    Article  PubMed  CAS  Google Scholar 

  15. Shah BR, Laupacis A, Hux JE, et al. Propensity score methods gave similar results to traditional regression modeling in observational studies: a systematic review. J Clin Epidemiol. 2005;58:550–9.

    Article  PubMed  Google Scholar 

  16. Levine GN, Bates ER, Blankenship JC, et al. 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. J Am Coll Cardiol. 2011;58:2550–83.

    Article  Google Scholar 

  17. Antman EM, Anbe DT, Armstrong PW, et al. 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). J Am Coll Cardiol. 2004;44:E1–E211.

    Article  PubMed  Google Scholar 

  18. Van de Werf F, Bax J, Betriu A, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008;29:2909–45.

    Article  PubMed  Google Scholar 

  19. Barron HV, Every NR, Parsons LS, et al. The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2. Am Heart J. 2001;141:933–9.

    Article  PubMed  CAS  Google Scholar 

  20. LeDoux JF, Tamareille S, Felli PR, et al. Left ventricular unloading with intra-aortic counter pulsation prior to reperfusion reduces myocardial release of endothelin-1 and decreases infarction size in a porcine ischemia-reperfusion model. Catheter Cardiovasc Interv. 2008;72:513–21.

    Article  PubMed  Google Scholar 

  21. Allen BS, Okamoto F, Buckberg GD, et al. Reperfusion conditions: critical importance of total ventricular decompression during regional reperfusion. J Thorac Cardiovasc Surg. 1986;92:605–12.

    PubMed  CAS  Google Scholar 

  22. Thiele H, Sick P, Boudriot E, et al. Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J. 2005;26:1276–83.

    Article  PubMed  Google Scholar 

  23. Perera D, Stables R, Thomas M, et al. Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. JAMA. 2010;304:867–74.

    Article  PubMed  CAS  Google Scholar 

  24. Patel MR, Smalling RW, Thiele H, et al. Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: the CRISP AMI randomized trial. JAMA. 2011;306:1329–37.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Academic Medical Center–University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands

    K. D. Sjauw, A. E. Engström, M. M. Vis, W. Boom, J. Baan Jr., R. J. de Winter, J. G. P. Tijssen, J. J. Piek & J. P. S. Henriques

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  1. K. D. Sjauw
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  2. A. E. Engström
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  3. M. M. Vis
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  4. W. Boom
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  5. J. Baan Jr.
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  6. R. J. de Winter
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  7. J. G. P. Tijssen
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  8. J. J. Piek
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  9. J. P. S. Henriques
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Correspondence to K. D. Sjauw.

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Sjauw, K.D., Engström, A.E., Vis, M.M. et al. Efficacy and timing of intra-aortic counterpulsation in patients with ST-elevation myocardial infarction complicated by cardiogenic shock. Neth Heart J 20, 402–409 (2012). https://doi.org/10.1007/s12471-012-0312-8

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  • DOI: https://doi.org/10.1007/s12471-012-0312-8

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