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Unprotected Left Main Percutaneous Coronary Intervention With or Without Hemodynamic Support
Nauman Khalid1, Cheng Zhang1, Corey Shea1
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
Insights
Unprotected left main percutaneous coronary interventions (ULMPCI) without intra-aortic balloon pump (IABP) support showed similar outcomes to those with IABP. Unsupported ULMPCI also resulted in shorter hospital stays, suggesting a need for further randomized trials.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Hemodynamic support, such as intra-aortic balloon pump (IABP), is frequently used during unprotected left main (ULM) percutaneous coronary interventions (PCI).
- However, evidence from randomized studies supporting routine IABP use in ULMPCI is lacking, and device-related complications are a concern.
Purpose of the Study:
- To compare the clinical, procedural, and cardiovascular outcomes of ULMPCI performed with and without elective intra-aortic balloon pump (IABP) support.
- To evaluate the safety and efficacy of unsupported ULMPCI versus IABP-supported ULMPCI.
Main Methods:
- A single-center, retrospective analysis of 217 patients undergoing non-emergent ULMPCI between 2003 and 2018.
- Patients were divided into two groups: those who received elective IABP support (n=55) and those who did not (n=162).
- Comparison of procedural success, in-hospital and 30-day mortality, major complications, and length of hospital and intensive care unit stay.
Main Results:
- Procedural success rates were high in both groups (99% with IABP, 95.3% without IABP; p=0.089).
- In-hospital and 30-day mortality rates were similar between the IABP and No-IABP groups (5.5% vs. 5.6%; p=0.977).
- Rates of major complications were comparable, although the IABP group experienced longer hospital and ICU stays. Bailout IABP was needed in 10% of the No-IABP group.
Conclusions:
- Unprotected left main percutaneous coronary interventions (ULMPCI) performed without intra-aortic balloon pump (IABP) support were not associated with increased mortality or major adverse cardiovascular outcomes compared to those with IABP.
- Unsupported ULMPCI was associated with shorter hospital and intensive care unit lengths of stay.
- A randomized trial is warranted to definitively identify patient subgroups who may benefit from hemodynamic support during ULMPCI.
Abstract:
Hemodynamic support is widely utilized for unprotected left main (ULM) percutaneous coronary interventions (PCI) despite lack of evidence from randomized studies and the risk of device-related complications. We aimed to compare ULMPCI with and without intra-aortic balloon pump (IABP) support. A single-center, retrospective analysis was performed for patients undergoing ULMPCI with and without IABP support. Clinical, procedural, in-hospital, and 30-day cardiovascular outcomes were compared. From 2003 through 2018, 217 patients underwent non-emergent ULMPCI, 55 with elective IABP support (IABP group), and 162 without support (No-IABP group). The study population comprised 56.4% men and 74.5% Caucasians in the IABP group and 53.7% men and 62.3% Caucasians in the No-IABP group. The mean age for IABP and No-IABP group patients was 75.75 ± 12.34 years and 73.47 ± 15.19 years, respectively (p = 0.315). Procedural success was achieved in 99% of IABP and 95.3% of No-IABP patients (p = 0.089). In-hospital and 30-day mortality was 5.5% for the IABP group and 5.6% for the No-IABP group (p = 0.977). Rates of major complications were statistically similar between the groups. Bailout IABP was required in 10% of No-IABP patients. Hospital and intensive care unit length of stay was statistically longer in the IABP group. In conclusion, ULMPCI without IABP support was not associated with increased mortality and major cardiovascular outcomes compared with supported patients and was associated with shorter hospital and intensive care unit stay. A randomized trial comparing unsupported versus supported ULMPCI is warranted to identify patients who would benefit from hemodynamic support.
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