title: The Effects of Intra-Aortic Balloon Pumps on Mortality in Patients Undergoing High-Risk Coronary Revascularization: A Meta-Analysis of Randomized Controlled Trials of Coronary Artery Bypass Grafting and Stenting Era.
abstract: BACKGROUND
  Intra-aortic balloon pumps (IABP) have generally been used for patients undergoing high-risk mechanical coronary revascularization. However, there is still insufficient evidence to determine whether they can improve outcomes in reperfusion therapy patients, mainly by percutaneous coronary intervention (PCI) with stenting or coronary artery bypass graft (CABG). This study was designed to determine the difference between high-risk mechanical coronary revascularization with and without IABPs on mortality, by performing a meta-analysis on randomized controlled trials of the current era.
  
  
  METHODS
  Pubmed and Embase databases were searched from inception to May 2015. Unpublished data were obtained from the investigators. Randomized clinical trials of IABP and non-IABP in high-risk coronary revascularization procedures (PCI or CABG) were included. In the case of PCI procedures, stents should be used in more than 80% of patients. Numbers of events at the short-term and long-term follow-up were extracted.
  
  
  RESULTS
  A total of 12 randomized trials enrolling 2155 patients were included. IABPs did not significantly decrease short-term mortality (relative risk (RR) 0.66; 95% CI, 0.42-1.01), or long-term mortality (RR 0.79; 95% CI, 0.47-1.35), with low heterogeneity across the studies. The findings remained stable in patients with acute myocardial infarction with or without cardiogenic shock. But in high-risk CABG patients, IABP was associated with reduced mortality (71 events in 846 patients; RR 0.40; 95%CI 0.25-0.67).
  
  
  CONCLUSIONS
  In patients undergoing high-risk coronary revascularization, IABP did not significantly decrease mortality. But high-risk CABG patients may be benefit from IABP. Rigorous criteria should be applied to the use of IABPs.
authors.affiliation: Department of Integrated ICU, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.
authors.forename: You-Dong
authors.initials: YD
authors.lastname: Wan
authors.affiliation: Department of Integrated ICU, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.
authors.forename: Tong-Wen
authors.initials: TW
authors.lastname: Sun
authors.affiliation: Pharmaceutical Department, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.
authors.forename: Quan-Cheng
authors.initials: QC
authors.lastname: Kan
authors.affiliation: Academy of Medical Science, Henan Province, Zhengzhou, PR China.
authors.forename: Fang-Xia
authors.initials: FX
authors.lastname: Guan
authors.affiliation: Department of Integrated ICU, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.
authors.forename: Zi-Qi
authors.initials: ZQ
authors.lastname: Liu
authors.affiliation: Department of Integrated ICU, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China.
authors.forename: Shu-Guang
authors.initials: SG
authors.lastname: Zhang
mesh_terms: D001026:Coronary Artery Bypass / Q000009:adverse effects; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects*; D009026:Mortality / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome