Preoperative Intraaortic Balloon Pump Improves Early Outcomes Following High-Risk Coronary Artery Bypass Graft Surgery: A Meta-Analysis of Randomized Trials and Prospective Study Design

Despite widespread use, evidence to support preemptive intraaortic balloon pump (IABP) insertion for patients undergoing high-risk coronary artery bypass graft (CABG) surgery remains sparse, and in need of a well-defined clinical trial. To inform the design of a prospective trial, we sought to revie...

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Bibliographic Details
Published in:The Journal of invasive cardiology 2018-01, Vol.30 (1), p.2-9
Main Authors: Rampersad, Penelope P, Udell, Jacob A, Zawi, Rami, Ouzounian, Maral, Overgaard, Christopher B, Sharma, Vinoda, Rao, Vivek, Farkouh, Michael E, Džavík, Vladimír
Format: Article
Language:English
Subjects:
Coronary Artery Bypass - adverse effects
Coronary Artery Bypass - methods
Coronary Artery Disease - surgery
Humans
Intra-Aortic Balloon Pumping - methods
Intra-Aortic Balloon Pumping - statistics & numerical data
Outcome and Process Assessment (Health Care)
Preoperative Care - methods
Randomized Controlled Trials as Topic
Secondary Prevention - methods
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Summary:Despite widespread use, evidence to support preemptive intraaortic balloon pump (IABP) insertion for patients undergoing high-risk coronary artery bypass graft (CABG) surgery remains sparse, and in need of a well-defined clinical trial. To inform the design of a prospective trial, we sought to review outcomes in randomized controlled trials (RCTs) of anticipatory IABP use vs control in patients undergoing high-risk CABG through meta-analysis. The primary endpoint was all-cause mortality within 30 days of surgery. The secondary endpoint was major adverse cardiac and cerebrovascular event (MACCE), a composite of death, myocardial infarction, stroke, or repeat revascularization. Using Ovid MEDLINE, we systematically reviewed all RCTs comparing preoperative IABP with control in patients undergoing high-risk CABG, defined as: left ventricular ejection fraction (LVEF) ≤40%, left main stenosis ≥70%, unstable angina, recent myocardial infarction, or prior myocardial revascularization undergoing elective or emergent CABG on or off pump. Of 950 articles assessed for eligibility, 10 RCTs of 1261 subjects (mean age, 65.0 years; 21.8% women; mean LVEF, 35%) were included. Mortality was significantly lower in patients receiving IABP compared with control (relative risk [RR], 0.48; 95% confidence interval [CI], 0.30-0.76; P
ISSN:1557-2501