title: Elective versus provisional intraaortic balloon pumping in unprotected left main stenting.
abstract: BACKGROUND
  Elective intraaortic balloon pump (IABP) may reduce acute complications during unprotected left main (ULM) stenting. However, few data exist on criteria for elective IABP support during ULM stenting.
  
  
  METHODS
  Since January 1993, 219 consecutive patients underwent elective ULM stenting: 69 had elective IABP support (elective IABP group), whereas 150 patients had conventional procedure (conservative group). Criteria for elective IABP support were (1) lesion located in the distal segment of the left main (bifurcation lesion), (2) left ventricular ejection fraction <40%, (3) atherectomy, (4) unstable angina, and (5) critical disease of the right coronary artery. Incidence of intraprocedural major adverse cardiac events (eg, severe hypotension and/or shock, myocardial infarction, urgent bypass surgery, and death) was assessed.
  
  
  RESULTS
  Euroscore >6 (identifying high-risk patients) occurred in 38% in the elective IABP group and 13% in the conservative group (P < .001). Severe hemodynamic instability occurred in 12 patients (8%) in the conservative group and in none in the elective IABP group (P = .020). Intraprocedural major adverse cardiac event was higher in the conservative group (9.5% vs 1.5%, P = .032). Elective IABP support (OR 0.08, 95% CI 0.01-0.69, P = .022) and presence of Euroscore >6 plus bifurcation lesion (OR 5.49; 95% CI 1.47-20.51; P = .011) were the independent predictors of intraprocedural events.
  
  
  CONCLUSIONS
  Elective IABP may prevent intraprocedural events in elective ULM stenting, especially in patients at higher risk.
authors.affiliation: Department of Interventional Cardiology, Vita-Salute University School of Medicine, San Raffaele Hospital, Milan, Italy. brigouri.carlo.hsr.it
authors.forename: Carlo
authors.initials: C
authors.lastname: Briguori
authors.forename: Flavio
authors.initials: F
authors.lastname: Airoldi
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Giuseppe Massimo
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Nuccia
authors.initials: N
authors.lastname: Morici
authors.forename: Iassen
authors.initials: I
authors.lastname: Michev
authors.forename: Ioannis
authors.initials: I
authors.lastname: Iakovou
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000295:instrumentation; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents