Elective versus provisional intra-aortic balloon pumping in high-risk percutaneous transluminal coronary angioplasty.
BACKGROUND
Elective intra-aortic balloon pump (IABP) support may reduce acute complications occurring during percutaneous coronary interventions (PCI) in patients with severe depression of the left ventricular ejection fraction (EF < or = 30%).


METHODS
Since February 1998, 133 consecutive patients with EF < or =30% underwent elective PCI in our institution; 61 had elective preprocedural IABP support (group A) and 72 patients had conventional PCI (group B). Jeopardy score was calculated in each patient from the coronary angiograms to quantify the myocardium at risk.


RESULTS
EF was similar in the 2 groups. Jeopardy score was higher in group A (8.0 +/- 2.8 vs 6.7 +/- 2.4, P =.008). The other principal clinical and angiographic characteristics were similar in the 2 groups. Severe hypotension and/or shock occurred in 11 patients, all in group B (P =.001). All required urgent IABP support, and 3 eventually died. Intraprocedural major adverse cardiac and cerebral events (eg, myocardial infarction, severe hypotension and/or shock, urgent bypass surgery, stroke, and death) were higher in group B (17% vs 0%, P =.001). By stepwise logistic regression analysis, elective IABP support (odds ration [OR] 0.11 [95% CI 0.21-0.60], P =.011), jeopardy score (OR 5.37 [95% CI 1.10-8.70], P =.040), and female sex (OR 2.72 [95% CI 1.85-3.10], P =.015), were the correlates of intraprocedural events.


CONCLUSIONS
This study supports the potential usefulness of elective versus provisional IABP to prevent intraprocedural major adverse cardiac and cerebral events in high-risk PCI.
Briguori
Carlo
C
Department of Interventional Cardiology, Vita-Salute University School of Medicine, San Raffaele Hospital, and EMO Centro Cuore Columbus, Milan, Italy. carlo.briguori@hsr.it
Sarais
Cristiano
C
Pagnotta
Paolo
P
Airoldi
Flavio
F
Liistro
Francesco
F
Sgura
Fabio
F
Spanos
Vassilis
V
Carlino
Mauro
M
Montorfano
Matteo
M
Di Mario
Carlo
C
Colombo
Antonio
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012307:Risk Factors; D013318:Stroke Volume