Contemporary utilization and outcomes of intra-aortic balloon counterpulsation in acute myocardial infarction: the benchmark registry.
OBJECTIVE
We sought to examine contemporary utilization patterns and clinical outcomes in patients with acute myocardial infarction (AMI) requiring intra-aortic balloon pump (IABP) counterpulsation.


BACKGROUND
Despite increasing experience with and broadened indications for intra-aortic counterpulsation, the current indications, associated complications, and clinical outcomes of IABP use in AMI are unknown.


METHODS
Between June 1996 and August 2001, data were prospectively collected from 22,663 consecutive patients treated with aortic counterpulsation at 250 medical centers worldwide; 5,495 of these patients had AMI.


RESULTS
Placement of an IABP in AMI patients was most frequently indicated for cardiogenic shock (27.3%), hemodynamic support during catheterization and/or angioplasty (27.2%) or prior to high-risk surgery (11.2%), mechanical complications of AMI (11.7%), and refractory post-myocardial infarction unstable angina (10.0%). Balloon insertions were successful in 97.7% of patients. Diagnostic catheterization was performed in 96% of patients, and 83% underwent coronary revascularization before hospital discharge. The in-hospital mortality rate was 20.0% (38.7% in patients with shock) and varied markedly by indication and use of revascularization procedures. Major IABP complications occurred in only 2.7% of patients, despite median use for three days, and early IABP discontinuation was required in only 2.1% of patients.


CONCLUSIONS
With contemporary advances in device technology, insertion technique, and operator experience, IABP counterpulsation may be successfully employed for a wide variety of conditions in the AMI setting, providing significant hemodynamic support with rare major complications in a high-risk patient population.
Stone
Gregg W
GW
Cardiovascular Research Foundation and Lenox Hill Hospital, 55 East 59th Street, 6th Floor, New York, NY 10022, USA. gstone@crf.org
Ohman
E Magnus
EM
Miller
Michael F
MF
Joseph
Debra L
DL
Christenson
Jan T
JT
Cohen
Marc
M
Urban
Philip M
PM
Reddy
Ramachandra C
RC
Freedman
Robert J
RJ
Staman
Karen L
KL
Ferguson
James J
JJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D015908:Counterpulsation / Q000706:statistics & numerical data*; D020878:Device Removal; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology