Georg Fuernau1,2, Jakob Ledwoch3, Steffen Desch2,4, Ingo Eitel1,2, Nathalie Thelemann1, Christian Jung5, Suzanne de Waha-Thiele1,2, Janine Pöss4, Hans-Josef Feistritzer4, Anne Freund4, Steffen Schneider6, Taoufik Ouarrak6, Karl Werdan7, Uwe Zeymer6,8, Holger Thiele4. 1. Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Heart Centre Lübeck, Germany. 2. German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany. 3. Department of Cardiology, Pulmonology and Critical Care, München Klinik Neuperlach, Germany. 4. Department of Internal Medicine/Cardiology, Heart Centre Leipzig at University of Leipzig and Leipzig Heart Institute, Germany. 5. Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Germany. 6. Institut für Herzinfarktforschung, Germany. 7. Clinic for Internal Medicine III, University Hospital Halle (Saale), Martin-Luther University Halle-Wittenberg, Germany. 8. Medical Clinic B, Klinikum Ludwigshafen, Germany.
Abstract
BACKGROUND: Conflicting results exist on whether initiation of intraaortic balloon pumping (IABP) before percutaneous coronary intervention (PCI) has an impact on outcome in this setting. Our aim was to assess the outcome of patients undergoingIABP insertion before versus after primary PCI in acute myocardial infarction complicated by cardiogenic shock. METHODS: The IABP-SHOCK II-trial randomized 600 patients with acute myocardial infarction and cardiogenic shock to IABP-support versus control. We analysed the outcome of patients randomized to the intervention group regarding timing of IABP implantation before or after PCI. RESULTS: Of 600 patients included in the IABP-SHOCK II trial, 301 were randomized to IABP-support. We analysed the 275 (91%) patients of this group undergoing primary PCI as revascularization strategy surviving the initial procedure. IABP insertion was performed before PCI in 33 (12%) and after PCI in 242 (88%) patients. There were no differences in baseline arterial lactate (p = 0.70), Simplified Acute Physiology Score-II-score (p = 0.60) and other relevant baseline characteristics. No differences were observed for short- and long-term mortality (pre vs. post 30-day mortality: 36% vs. 37%, odds ratio 0.99, 95% confidence interval (CI) 0.47-2.12, p = 0.99; one-year mortality: 56% vs. 48%, hazard ratio 1.08, 95% CI 0.65-1.80, p = 0.76; six-year-mortality: 64% vs. 65%, hazard ratio 1.00, 95% CI 0.63-1.60, p = 0.99). In multivariable Cox regression analysis timing of IABP-implantation was no predictor for long-term outcome (hazard ratio 1.08, 95% CI 0.66-1.78, p = 0.75). CONCLUSIONS: Timing of IABP-implantation pre or post primary PCI had no impact on outcome in patients with acute myocardial infarction complicated by cardiogenic shock.
RCT Entities:
BACKGROUND: Conflicting results exist on whether initiation of intraaortic balloon pumping (IABP) before percutaneous coronary intervention (PCI) has an impact on outcome in this setting. Our aim was to assess the outcome of patients undergoing IABP insertion before versus after primary PCI in acute myocardial infarction complicated by cardiogenic shock. METHODS: The IABP-SHOCK II-trial randomized 600 patients with acute myocardial infarction and cardiogenic shock to IABP-support versus control. We analysed the outcome of patients randomized to the intervention group regarding timing of IABP implantation before or after PCI. RESULTS: Of 600 patients included in the IABP-SHOCK II trial, 301 were randomized to IABP-support. We analysed the 275 (91%) patients of this group undergoing primary PCI as revascularization strategy surviving the initial procedure. IABP insertion was performed before PCI in 33 (12%) and after PCI in 242 (88%) patients. There were no differences in baseline arterial lactate (p = 0.70), Simplified Acute Physiology Score-II-score (p = 0.60) and other relevant baseline characteristics. No differences were observed for short- and long-term mortality (pre vs. post 30-day mortality: 36% vs. 37%, odds ratio 0.99, 95% confidence interval (CI) 0.47-2.12, p = 0.99; one-year mortality: 56% vs. 48%, hazard ratio 1.08, 95% CI 0.65-1.80, p = 0.76; six-year-mortality: 64% vs. 65%, hazard ratio 1.00, 95% CI 0.63-1.60, p = 0.99). In multivariable Cox regression analysis timing of IABP-implantation was no predictor for long-term outcome (hazard ratio 1.08, 95% CI 0.66-1.78, p = 0.75). CONCLUSIONS: Timing of IABP-implantation pre or post primary PCI had no impact on outcome in patients with acute myocardial infarction complicated by cardiogenic shock.
Authors: Alastair G Proudfoot; Antonis Kalakoutas; Susanna Meade; Mark J D Griffiths; Mir Basir; Francesco Burzotta; Sharon Chih; Eddy Fan; Jonathan Haft; Nasrien Ibrahim; Natalie Kruit; Hoong Sern Lim; David A Morrow; Jun Nakata; Susanna Price; Carolyn Rosner; Robert Roswell; Mark A Samaan; Marc D Samsky; Holger Thiele; Alexander G Truesdell; Sean van Diepen; Michelle Doughty Voeltz; Peter M Irving Journal: Circ Heart Fail Date: 2021-11-22 Impact factor: 8.790