Contemporary utilization and outcomes of intra-aortic balloon counterpulsation in acute myocardial infarction: The Benchmark Registry

• Published in: Journal of the American College of Cardiology 2003-06, Vol.41 (11), p.1940-1947
• Main Authors: STONE, Grgg W, OHMAN, E. Magnus, FERGUSON, James J, MILLER, Michael F, JOSEPH, Debra L, CHRISTENSON, Jan T, COHEN, Marc, URBAN, Philip M, REDDY, Ramachandra C, FREEDMAN, Robert J, STAMAN, Karen L
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Cardiology; Clinical outcomes; Coronary Angiography; Coronary vessels; Counterpulsation - statistics & numerical data; Device Removal; Diseases of the cardiovascular system; Female; Heart attacks; Hospital Mortality; Hospitals; Humans; Intra-Aortic Balloon Pumping - statistics & numerical data; Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - mortality; Myocardial Infarction - surgery; Myocardial Revascularization; Postoperative Complications - etiology; Postoperative Complications - mortality; Predictive Value of Tests; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stroke Volume - physiology; Treatment Outcome; United States - epidemiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(03)00400-5

We sought to examine contemporary utilization patterns and clinical outcomes in patients with acute myocardial infarction (AMI) requiring intra-aortic balloon pump (IABP) counterpulsation. Despite increasing experience with and broadened indications for intra-aortic counterpulsation, the current indications, associated complications, and clinical outcomes of IABP use in AMI are unknown. Between June 1996 and August 2001, data were prospectively collected from 22,663 consecutive patients treated with aortic counterpulsation at 250 medical centers worldwide; 5,495 of these patients had AMI. Placement of an IABP in AMI patients was most frequently indicated for cardiogenic shock (27.3%), hemodynamic support during catheterization and/or angioplasty (27.2%) or prior to high-risk surgery (11.2%), mechanical complications of AMI (11.7%), and refractory post-myocardial infarction unstable angina (10.0%). Balloon insertions were successful in 97.7% of patients. Diagnostic catheterization was performed in 96% of patients, and 83% underwent coronary revascularization before hospital discharge. The in-hospital mortality rate was 20.0% (38.7% in patients with shock) and varied markedly by indication and use of revascularization procedures. Major IABP complications occurred in only 2.7% of patients, despite median use for three days, and early IABP discontinuation was required in only 2.1% of patients. With contemporary advances in device technology, insertion technique, and operator experience, IABP counterpulsation may be successfully employed for a wide variety of conditions in the AMI setting, providing significant hemodynamic support with rare major complications in a high-risk patient population.