Journal
CIRCULATION
Volume 127, Issue 2, Pages 207-212Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCULATIONAHA.112.132209
Keywords
high-risk populations; intra-aortic balloon pump; ischemic cardiomyopathy; mortality; percutaneous coronary intervention
Funding
- British Cardiovascular Intervention Society
- Maquet Cardiovascular (Mawah, NJ)
- Cordis (Wokingham, UK)
- Johnson & Johnson (Wokingham, UK)
- UK Department of Health via the National Institute for Health Research Comprehensive Biomedical Research Center
- National Institute for Health Research [10/57/67] Funding Source: researchfish
Ask authors/readers for more resources
Background-There is conflicting evidence on the utility of elective intra-aortic balloon pump (IABP) use during high-risk percutaneous coronary intervention (PCI). Observational series have indicated a reduction in major in-hospital adverse events, although randomized trial evidence does not support this. A recent study has suggested a mortality benefit trend early after PCI, but there are currently no long-term outcome data from randomized trials in this setting. Methods and Results-Three hundred one patients with left ventricular impairment (ejection fraction < 30%) and severe coronary disease (BCIS-1 jeopardy score >= 8; maximum possible score=12) were randomized to receive PCI with elective IABP support (n=151) or without planned IABP support (n=150). Long-term all-cause mortality was assessed by tracking the databases held at the Office of National Statistics (in England and Wales) and the General Register Office (in Scotland). The groups were balanced in terms of baseline characteristics (left ventricular ejection fraction, 23.6%; BCIS-1 jeopardy score, 10.4) and the amount and type of revascularization performed. Mortality data were available for the entire cohort at a median of 51 months (interquartile range, 41-58) from randomization. All-cause mortality at follow-up was 33% in the overall cohort, with significantly fewer deaths occurring in the elective IABP group (n=42) than in the group that underwent PCI without planned IABP support (n=58) (hazard ratio, 0.66; 95% confidence interval, 0.44-0.98; P=0.039). Conclusions-In patients with severe ischemic cardiomyopathy treated with PCI, all-cause mortality was 33% at a median of 51 months. Elective IABP use during PCI was associated with a 34% relative reduction in all-cause mortality compared with unsupported PCI. Clinical Trial Registration-URL: http://www.isrctn.org. Unique identifier: ISRCTN40553718; and http://www.clinicaltrials.gov. Unique identifier: NCT00910481. (Circulation. 2013;127:207-212.)
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available