Home > Uncategorized > Journal Club 5 September 2012

Journal Club 5 September 2012

Paper

Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock

Presenter

AC

Summary

Background

In current international guidelines, intraaortic balloon counterpulsation is considered
to be a class I treatment for cardiogenic shock complicating acute myocardial
infarction. However, evidence is based mainly on registry data, and there is a paucity
of randomized clinical trials.

Methods

In this randomized, prospective, open-label, multicenter trial, we randomly assigned
600 patients with cardiogenic shock complicating acute myocardial infarction to
intraaortic balloon counterpulsation (IABP group, 301 patients) or no intraaortic
balloon counterpulsation (control group, 299 patients). All patients were expected
to undergo early revascularization (by means of percutaneous coronary intervention
or bypass surgery) and to receive the best available medical therapy. The primary
efficacy end point was 30-day all-cause mortality. Safety assessments included major
bleeding, peripheral ischemic complications, sepsis, and stroke.

Results

A total of 300 patients in the IABP group and 298 in the control group were included
in the analysis of the primary end point. At 30 days, 119 patients in the IABP group
(39.7%) and 123 patients in the control group (41.3%) had died (relative risk with
IABP, 0.96; 95% confidence interval, 0.79 to 1.17; P = 0.69). There were no significant
differences in secondary end points or in process-of-care measures, including the
time to hemodynamic stabilization, the length of stay in the intensive care unit,
serum lactate levels, the dose and duration of catecholamine therapy, and renal function.
The IABP group and the control group did not differ significantly with respect
to the rates of major bleeding (3.3% and 4.4%, respectively; P = 0.51), peripheral
ischemic complications (4.3% and 3.4%, P = 0.53), sepsis (15.7% and 20.5%, P = 0.15),
and stroke (0.7% and 1.7%, P = 0.28).

Conclusions

The use of intraaortic balloon counterpulsation did not significantly reduce 30-day
mortality in patients with cardiogenic shock complicating acute myocardial infarction
for whom an early revascularization strategy was planned.

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