Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial
Related Experiment Video
Updated: Jun 23, 2026
Post-Myocardial Infarction Heart Failure in Closed-chest Coronary Occlusion/Reperfusion Model in Göttingen Minipigs and Landrace Pigs
Published on: April 17, 2021
Divaka Perera1, Rodney Stables, Martyn Thomas
1Cardiovascular Division, King's College London, London SE1 7EH, UK.
Insights
Routine intra-aortic balloon pump (IABP) insertion before high-risk percutaneous coronary intervention (PCI) did not reduce major adverse cardiac events. This randomized trial found no benefit, questioning the routine use of IABP in such patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Trials
Background:
- Observational studies suggested elective intra-aortic balloon pump (IABP) insertion may improve outcomes after high-risk percutaneous coronary intervention (PCI).
- No randomized trial had previously validated this assertion.
- This study aimed to rigorously test the efficacy of routine IABP use in a specific high-risk patient group.
Purpose of the Study:
- To determine if routine intra-aortic balloon counterpulsation before PCI reduces major adverse cardiac and cardiovascular events (MACCE).
- To assess the impact of IABP on MACCE in patients with severe left ventricular dysfunction and extensive coronary disease.
Main Methods:
- A prospective, open-label, multicenter, randomized controlled trial (Balloon Pump-Assisted Coronary Intervention Study).
- 301 patients with ejection fraction ≤30% and Jeopardy Score ≥8/12 were randomized.
- Patients received either elective IABP insertion before PCI or no planned IABP.
Main Results:
- No significant difference in MACCE at hospital discharge between the elective IABP group (15.2%) and the no planned IABP group (16.0%; P=.85).
- All-cause mortality at 6 months was similar (4.6% vs 7.4%; P=.32).
- Major procedural complications were significantly lower with elective IABP (1.3% vs 10.7%; P<.001), but bleeding and access-site complications showed non-significant trends towards increase.
Conclusions:
- Elective IABP insertion did not reduce MACCE in patients undergoing high-risk PCI.
- The findings do not support routine IABP placement for all patients with severe left ventricular dysfunction and extensive coronary disease.
- While IABP reduced procedural complications, the lack of overall outcome benefit makes its routine use questionable.
Context:
Observational studies have previously reported that elective intra-aortic balloon pump (IABP) insertion may improve outcomes following high-risk percutaneous coronary intervention (PCI). To date, this assertion has not been tested in a randomized trial.
Objective:
To determine whether routine intra-aortic balloon counterpulsation before PCI reduces major adverse cardiac and cardiovascular events (MACCE) in patients with severe left ventricular dysfunction and extensive coronary disease.
Design, Setting, And Patients:
The Balloon Pump-Assisted Coronary Intervention Study, a prospective, open, multicenter, randomized controlled trial conducted in 17 tertiary referral cardiac centers in the United Kingdom between December 2005 and January 2009. Patients (n = 301) had severe left ventricular dysfunction (ejection fraction < or = 30%) and extensive coronary disease (Jeopardy Score > or = 8/12); those with contraindications to or class I indications for IABP therapy were excluded.
Intervention:
Elective insertion of IABP before PCI.
Main Outcome Measures:
Primary end point was MACCE, defined as death, acute myocardial infarction, cerebrovascular event, or further revascularization at hospital discharge (capped at 28 days). Secondary end points included all-cause mortality at 6 months, major procedural complications, bleeding, and access-site complications.
Results:
MACCE at hospital discharge occurred in 15.2% (23/151) of the elective IABP and 16.0% (24/150) of the no planned IABP groups (P = .85; odds ratio [OR], 0.94 [95% confidence interval {CI}, 0.51-1.76]). All-cause mortality at 6 months was 4.6% and 7.4% in the respective groups (P = .32; OR, 0.61 [95% CI, 0.24-1.62]). Fewer major procedural complications occurred with elective IABP insertion compared with no planned IABP use (1.3% vs 10.7%, P < .001; OR, 0.11 [95% CI, 0.01-0.49]). Major or minor bleeding occurred in 19.2% and 11.3% (P = .06; OR, 1.86 [95% CI, 0.93-3.79]) and access-site complications in 3.3% and 0% (P = .06) of the elective and no planned IABP groups, respectively.
Conclusions:
Elective IABP insertion did not reduce the incidence of MACCE following PCI. These results do not support a strategy of routine IABP placement before PCI in all patients with severe left ventricular dysfunction and extensive coronary disease.
Trial Registration:
isrctn.org Identifier: ISRCTN40553718; clinicaltrials.gov Identifier: NCT00910481.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:27Peripheral Artery Disease III: Interprofessional Care