Elective Balloon Pump Use Improves Outcomes of High Risk Coronary Interventions

NEW YORK (Reuters Health) – Elective placement of an intra-aortic balloon pump during percutaneous coronary interventions (PCI) in patients with heart failure can reduce the risk of major adverse events.

The finding is based on a study of 133 consecutive patients, with ejection fractions no greater than 30%, who underwent PCI between 1998 and 2000 at a center in Italy. The group included 61 patients who had an intra-aortic balloon pump (IABP) placed electively before PCI and 72 patients who received an IABP only if hemodynamic instability occurred during PCI.

With the exception of elective IABP patients having more extensive multivessel disease, the two groups had similar clinical and angiographic characteristics, lead author Dr. Carlo Briguori, from San Raffaele Hospital in Milan, and colleagues note.

Severe hypotension and shock occurred in none of the patients in the elective IABP group, but in 11 patients in the provisional IABP group (p = 0.001). An IABP was placed emergently in these patients, but three eventually died.

Overall, none of the elective IABP patients experienced a major adverse event during PCI, but 17% of patients in the provisional IABP group did (p = 0.001). On regression analysis, elective IABP support was tied to an 89% reduction in the risk of such events.

“When dealing with patients with severe depression in left ventricular ejection fraction and a large amount of myocardium at jeopardy, the operator should take into account a 20% risk of acute hemodynamic instability, which almost always will need urgent IABP support,” the authors note in the April issue of the American Heart Journal.

“Prophylactic use of IABP counterpulsation among these high-risk patients undergoing PCI seems to contribute to an uncomplicated and successful outcome,” they state.

Am Heart J 2003;145:700-707.