Short and long term effect of adjunctive intra-aortic balloon pump use for patients undergoing high risk reperfusion therapy: a meta-analysis of 10 international randomised trials

Objective Current literature shows there is widespread controversy regarding the indications and outcomes of using an intra-aortic balloon pump (IABP); furthermore, little is known about the late effects of IABP use. Design To determine whether IABP use can have beneficial effects for patients undergoing high risk reperfusion therapies, by conducting a meta-analysis of randomised trials. Setting Databases of Pubmed, Cochrane Library, and Clinicaltrials.gov were searched up to 15 June 2013. Patients Patients undergoing high risk reperfusion therapies. Interventions Randomised clinical trials comparing IABP with no IABP were considered eligible for this meta-analysis. Main outcome measures Primary outcomes were early (30-day) and long term (>= 6-month) mortality. Results Among the 1079 articles retrieved, 10 randomised studies with 2037 high risk patients were included in the quantitative analysis. Meta-analysis revealed that early mortality rate did not differ between the IABP group and the non-IABP group (OR 0.79, 95% CI 0.48 to 1.29). However, long term mortality was significantly reduced in the IABP group (OR 0.63, 95% CI 0.45 to 0.9), and this effect seemed more pronounced in the subset of patients treated with contemporary percutaneous coronary intervention (OR 0.55, 95% CI 0.38 to 0.80). Further analysis found that IABP use was associated with a reduced risk of 30-day re-ischaemia rate (OR 0.62, 95% CI 0.42 to 0.91) and the composite outcome of re-ischaemia and heart failure events (OR 0.75, 95% CI 0.58 to 0.98). No significant heterogeneity was observed. Conclusions This meta-analysis suggests that adjunctive IABP use in high risk reperfusion therapy can improve long term survival.