Intra-aortic balloon counterpulsation in US and non-US centres: results of the Benchmark Registry.
OBJECTIVE
To examine differences in patient characteristics and outcomes in 19636 patients enrolled in the USA and 3027 patients enrolled in other countries undergoing intra-aortic balloon pump (IABP) counterpulsation.


RESULTS
Indications for IABP use; a larger percentage of US patients were identified as 'early support and stabilization for angiography or angioplasty' (21.1% US vs 11.8% non-US), and 'pre-operative support for high-risk CABG' (15.9% vs 6.6%). A smaller percentage of US patients vs non-US patients were identified as 'weaning from cardiopulmonary bypass' (14.3% vs 28.2%), and 'refractory ventricular failure' (6.2% vs 9.8%). One out of five patients in both groups was listed as 'cardiogenic shock' (18.9% US vs 20.2% non-US). All cause, risk-adjusted, in-hospital mortality (20.1% vs 28.7%; P<0.001), and mortality with IABP in place (10.8% vs 18.0%; P<0.001) were lower at US vs non-US sites. In both US and non-US institutions, IABP associated complication rates, such as IABP-related mortality (0.05% vs 0.07%), major limb ischaemia (0.9% vs 0.8%), and severe bleeding (0.9% vs 0.8%), were low.


CONCLUSIONS
IABP counterpulsation is deployed at an earlier clinical stage in US patients. Mortality rates are higher for non-US patients, particularly for patients with non-surgery cardiac interventions, even after adjusting for risk factors. Complication rates were low. Physicians should therefore not be reluctant to use IABP in high-risk patients undergoing cardiac procedures.
Cohen
Marc
M
Division of Cardiology, MCP Hahnemann University School of Medicine, PA, Philadelphia, USA. marcohen@sbhcs.com
Urban
Philip
P
Christenson
Jan T
JT
Joseph
Debra L
DL
Freedman
Robert J
RJ
Miller
Michael F
MF
Ohman
E Magnus
EM
Reddy
Ramachandra C
RC
Stone
Gregg W
GW
Ferguson
James J
JJ
D000368:Aged; D001118:Argentina / Q000453:epidemiology; D044362:Australasia; D002170:Canada / Q000453:epidemiology; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D003325:Coronary Care Units; D003327:Coronary Disease / Q000401:mortality* / Q000628:therapy; D005060:Europe / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000401:mortality* / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008800:Mexico / Q000453:epidemiology; D011364:Professional Practice; D011446:Prospective Studies; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013997:Time Factors; D014481:United States / Q000453:epidemiology