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Published on: June 12, 2021
Preoperative intra-aortic balloon pump inserted in acute myocardial infarction patients without cardiogenic shock
Feng Yang1, Liangshan Wang1, Dengbang Hou1
1Center for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
Preoperative intra-aortic balloon pump use in acute myocardial infarction patients undergoing off-pump coronary artery bypass grafting did not improve survival. However, it did lead to shorter hospital stays, suggesting improved convalescence.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- The utility of preoperative intra-aortic balloon pump (IABP) in high-risk cardiac surgery remains debated.
- The specific role of preoperative IABP in acute myocardial infarction (AMI) patients without cardiogenic shock undergoing off-pump coronary artery bypass grafting (OPCABG) is not well-defined.
Purpose of the Study:
- To evaluate the efficacy and safety of preoperative IABP insertion in patients with AMI without cardiogenic shock undergoing OPCABG.
Main Methods:
- A retrospective observational study analyzed 421 consecutive AMI patients without cardiogenic shock who underwent isolated OPCABG.
- Propensity score matching created 99 pairs comparing patients who received preoperative IABP (n=157) versus those who did not (control group, n=264).
- Outcomes assessed included 30-day postoperative survival, complications, and hospital length of stay.
Main Results:
- Preoperative IABP did not significantly improve 30-day postoperative survival (HR 0.9; 95% CI 0.2-4.2; P=0.92).
- Patients receiving preoperative IABP experienced significantly shorter postoperative lengths of stay (8 vs. 10 days, P=0.02).
- Total hospital days were also decreased in the IABP group (18.2 vs. 21.8 days, P=0.02).
Conclusions:
- Preoperative IABP insertion in AMI patients without cardiogenic shock undergoing OPCABG does not enhance survival.
- However, preoperative IABP use is associated with improved convalescence, evidenced by significantly shorter hospital stays.
Objectives:
The benefit of preoperative intra-aortic balloon pump implantation in high-risk cardiac surgery patients is still debated. The role of preoperative intra-aortic balloon pump insertion in acute myocardial infarction patients without cardiogenic shock undergoing off-pump coronary artery bypass grafting remains unknown. This study aimed to determine the efficacy and safety of the preoperative intra-aortic balloon pump insertion in those patients undergoing off-pump coronary artery bypass grafting.
Methods:
A total of 421 consecutive acute myocardial infarction patients without cardiogenic shock who underwent isolated off-pump coronary artery bypass grafting were enrolled in this retrospective observational propensity score-matched analysis study. Patients who received intra-aortic balloon pump before off-pump coronary artery bypass grafting (the intra-aortic balloon pump group, n = 157) were compared with those who had not (control group, n = 264). The 30-day postoperative survival, postoperative complications, and postoperative hospital length of stay were compared between the two groups.
Results:
A total of 99 pairs of patients were matched. The preoperative intra-aortic balloon pump did not show a 30-day postoperative survival benefit compared with the control group (hazard ratio, 0.9; 95% confidence interval, 0.2-4.2; p = 0.92). Patients with preoperative intra-aortic balloon pump were more likely to have shorter postoperative lengths of stay (8 (6-11) days vs. 10 (6-15) days, p = 0.02) and decreased total days in the hospital (median days: 18.2 vs. 21.8, p = 0.02) compared to patients without balloon pumps.
Conclusion:
Preoperative intra-aortic balloon pump insertion in acute myocardial infarction patients without cardiogenic shock undergoing off-pump coronary artery bypass grafting improved convalescence as shown by significantly shorter postoperative lengths of hospital stay.
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