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Preoperative intra-aortic balloon pump in patients with ST-elevation myocardial infarction undergoing urgent cardiac
Veemal V Hemradj1,2, Alexander J Spanjersberg3, Marit Buitenhuis1
1Department of Cardiology, Isala Hospital, Zwolle, The Netherlands.
Insights
For ST-elevation myocardial infarction (STEMI) patients needing urgent coronary artery bypass grafting (CABG), preoperative intra-aortic balloon pump (IABP) insertion is linked to better survival. This study found IABP use reduced 30-day mortality in this high-risk group.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Devices
Background:
- Intra-aortic balloon pump (IABP) use in ST-elevation myocardial infarction (STEMI) without cardiogenic shock is not proven to lower mortality.
- Preoperative IABP insertion in STEMI patients undergoing urgent coronary artery bypass grafting (CABG) has shown potential mortality benefits.
Purpose of the Study:
- To investigate the impact of preoperative IABP use on 30-day mortality in STEMI patients who underwent urgent CABG.
Main Methods:
- A single-center study of consecutive STEMI patients undergoing urgent CABG from 2000-2018.
- Comparison of 30-day mortality between patients with and without preoperative IABP.
- Multivariable and subgroup analyses, including propensity score and inverse probability treatment weighting, were used to adjust for confounders.
Main Results:
- 246 patients were analyzed; 171 received a preoperative IABP.
- The preoperative IABP group had higher rates of cardiogenic shock, persistent ischemia, and reduced left ventricular function.
- After adjustment for confounders, preoperative IABP was associated with a reduced 30-day mortality (RR 0.52, 95% CI 0.30-0.88).
Conclusions:
- Preoperative IABP insertion is associated with reduced mortality in STEMI patients undergoing urgent CABG.
- IABP may be beneficial in selected high-risk STEMI patients undergoing urgent CABG.
Background:
In patients with ST-elevation myocardial infarction (STEMI), either with or without cardiogenic shock, mechanical circulatory support with an intra-aortic balloon pump (IABP) is not associated with lower mortality. However, in STEMI patients undergoing urgent coronary artery bypass grafting (CABG), preoperative insertion of an IABP has been suggested to reduce mortality. In this study, the effect of preoperative IABP use on mortality in STEMI patients undergoing urgent CABG was investigated.
Methods:
All consecutive STEMI patients undergoing urgent CABG in a single centre between 2000 and 2018 were studied. The primary outcome, 30-day mortality, was compared between patients with and without a preoperative IABP. Subgroup analysis and multivariable analysis using a propensity score and inverse probability treatment weighting were performed to adjust for potential confounders.
Results:
A total of 246 patients were included, of whom 171 (69.5%) received a preoperative IABP (pIABP group) and 75 (30.5%) did not (non-pIABP group). In the pIABP group, more patients suffered from cardiogenic shock, persistent ischaemia and reduced left ventricular function. Unadjusted 30-day mortality was comparable between the pIABP and the non-pIABP group (13.3% vs 12.3%, p = 0.82). However, after correction for confounders and inverse probability treatment weighting preoperative IABP was associated with reduced 30-day mortality (relative risk 0.52, 95% confidence interval 0.30-0.88).
Conclusion:
In patients with STEMI undergoing urgent CABG, preoperative insertion of an IABP is associated with reduced mortality.
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