OPCAB in acute coronary syndrome: predictors of intra-aortic balloon pump use.
OBJECTIVE
Acute coronary syndrome (ACS) patients undergoing offpump coronary artery bypass (OPCAB) often require intra-aortic balloon pump (IABP) support. Indications and timing of IABP insertion are controversial. A study was done to determine criteria for predicting the use of IABP in these patients.


METHODS
46 patients were operated for ACS within one week of event between January 2004 and July 2006 and categorized into, Unstable angina (UA) (n=25), with ongoing pain after late admission to emergency room (>6 hours) and acute myocardial infarction (AMI) (n=21) with AMI within 7 days of event.


RESULTS
There was no statistical difference in the demographic data of two groups. UA group had higher incidence of mitral regurgitation preoperatively (p = 0.004) which improved postoperatively (p = 0.1). IABP was usedpreoperatively more in AMI group (10 vs. 6, p = 0.03). Multivariate analysis revealed pressure ratio of mean pulmonary and systemic arteries as a predictor of IABP use (p = 0.01, odds ratio 19.4, 95% CI 1.9-190). There is a significant positive correlation (r = 0.519) between IABP use and ratio of mean pulmonary and systemic arterial pressures (p = 0.004) with cutoff value at 0.40.


CONCLUSIONS
Ratio of mean pulmonary and systemic artery of > 0.40 indicates preoperative use of IABP to complete the operation safely.
Chaudhary
Amit
A
Department of Cardiovascular and Thoracic Surgery and Cardiology Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP, India.
Pande
Shantanu
S
Agarwal
Surendra K
SK
Dhir
Udgeath
U
Tewari
Satyendra
S
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency; D015999:Multivariate Analysis; D016017:Odds Ratio; D012307:Risk Factors; D013223:Statistics as Topic; D013997:Time Factors; D014463:Ultrasonography