title: Clinical characteristics and outcomes after unplanned intraaortic balloon counterpulsation in the Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction trial.
abstract: BACKGROUND
  Despite advances in primary percutaneous coronary intervention (pPCI) and regional systems of care, the development of cardiogenic shock is associated with poor clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). We sought to better characterize the baseline characteristics and clinical outcomes of patients who underwent crossover to intraaortic balloon counterpulsation (IABC) in the CRISP AMI trial.
  
  
  METHODS
  Patients with anterior STEMI were randomized to IABC before pPCI or pPCI alone. Infarct size and 6-month clinical outcomes were evaluated in patients both in the pPCI-alone group who did undergo crossover to IABC and those who did not undergo crossover to IABC.
  
  
  RESULTS
  Among 176 patients randomized to pPCI alone, 161 patients did not later receive IABC during the index hospitalization, and 15 patients (8.5%) underwent crossover and did receive unplanned IABC. Hypotension and/or cardiogenic shock precipitated crossover to IABC in 12 patients (80%). Patients who underwent crossover to IABC demonstrated lower systolic and diastolic blood pressures on admission. At 6 months, rates of death (26.7% vs 3.1%, P = .003), readmission for severe hypotension (53.3% vs 3.7%, P < .001), resuscitated cardiac arrest, and ventricular arrhythmia were higher in the group that did crossover to IABC. Crossover to IABC was not associated with increased infarct size.
  
  
  CONCLUSIONS
  The most significant predictor of crossover to IABC in the setting of anterior STEMI was relative hypotension at the time of hospital admission, and crossover to IABC in CRISP AMI was associated with significantly worse clinical outcomes.
authors.affiliation: Division of Cardiology, Hennepin County Medical Center, Minneapolis, MN.
authors.forename: Louis P
authors.initials: LP
authors.lastname: Kohl
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Leimberger
authors.affiliation: Duke Clinical Research Institute, Durham, NC.
authors.forename: Karen
authors.initials: K
authors.lastname: Chiswell
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: W Schuyler
authors.initials: WS
authors.lastname: Jones
authors.affiliation: Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: Division of Cardiology, Memorial Hermann Heart and Vascular Institute, University of Texas, Houston, TX.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Smalling
authors.affiliation: Division of Cardiology, Medanta-The Medicity, Haryana, India.
authors.forename: Praveen
authors.initials: P
authors.lastname: Chandra
authors.affiliation: Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ.
authors.forename: Marc
authors.initials: M
authors.lastname: Cohen
authors.affiliation: Cardiovascular Division, King's College, London, UK.
authors.forename: Divaka
authors.initials: D
authors.lastname: Perera
authors.affiliation: Department of Cardiovascular Medicine, Flinders University, Bedford Park, Australia.
authors.forename: Derek P
authors.initials: DP
authors.lastname: Chew
authors.affiliation: Department of Cardiology, Liverpool Hospital, Liverpool, Australia.
authors.forename: John K
authors.initials: JK
authors.lastname: French
authors.affiliation: Department of Cardiology, Leeds General Infirmary, Leeds, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Blaxil
authors.affiliation: Citizens Hospital Nallagandla, Hyderabad, India.
authors.forename: A Sreenivas
authors.initials: AS
authors.lastname: Kumar
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.affiliation: Duke Clinical Research Institute, Durham, NC; Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC. Electronic address: manesh.patel@duke.edu.
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
mesh_terms: D018592:Cross-Over Studies; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D016896:Treatment Outcome