Pre-operative intra-aortic balloon counterpulsation in stable patients with left main coronary disease.
OBJECTIVE
To determine whether prophylactic, pre-operative, intra-aortic balloon counterpulsation (IABC) improves clinical outcome in stable patients with severe left main coronary artery disease.


METHODS
A post-hoc analysis of 457 prospectively tracked, non-randomized patients undergoing coronary artery bypass graft surgery (CABG) for left main stenoses 50% and multivessel coronary disease, but without any hemodynamic compromise or ongoing angina, was conducted. Patients with heart failure, shock, ongoing ischemia or previous CABG were excluded. In 287 patients, pre-operative IABC was not used (Group 1), while IABC was initiated in 170 patients for "prophylaxis" (Group 2).


RESULTS
Groups 1 and 2 were similar in age (67 +/- 10 years versus 67 +/- 11 years, respectively), sex (72% male versus 71% male, respectively), and body mass index (28 +/- 5.5 versus 27 +/- 5.1, respectively). However, more Group 1 patients had peripheral vascular disease (PVD) (25% versus 11%), but more Group 2 patients had diabetes (37% versus 29%), and a lower left ventricular ejection fraction. The unadjusted 30-day mortality was significantly higher in Group 1 [16 (5.6%) versus 2 (1.2%); p = 0.02]. Cardiopulmonary bypass time and post-operative length of stay did not differ between the two groups. After adjusting for PVD in the multivariate analysis, the p-value for the no IABP versus IABP comparison in the presence of PVD was 0.10, even though 0/18 patients with PVD and IABC died.


CONCLUSIONS
While unadjusted mortality appears lower with prophylactic IABC, confounding variables such as PVD mandate a larger, randomized clinical trial in order to establish the role of IABC in stable patients with left main disease.
Fasseas
P
P
Division of Cardiology, Department of Medicine, MCP Hahnemann University School of Medicine, Philadelphia, PA, USA.
Cohen
M
M
Kopistansky
C
C
Bowers
B
B
McCormick
D J
DJ
Kasper
K
K
Christenson
J T
JT
Parris
T M
TM
Miller
M F
MF
D000367:Age Factors; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000401:mortality; D003324:Coronary Artery Disease / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D023921:Coronary Stenosis / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000401:mortality*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000401:mortality; D015143:Philadelphia / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012042:Registries; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D016896:Treatment Outcome