IABPPCI? Is IABP Valuable for High-Risk PCI?
Physiological basis of IABP
Intra-aortic balloon pump: indications, efficacy, guidelines and future directions. Curr.Opin Cardiol Jul;29(4): IABP for High-Risk PCI High-risk PCI:
impaired left ventricular function significant ischemia risk in a large fraction of the myocardium impending hemodynamic instability acute myocardial infarction(AMI) Routine indications of IABP for high-risk PCI: cardiogenic shock ST-segment elevation myocardial infarction(STEMI) other high-risk situations Intra-aortic balloon pump: indications, efficacy, guidelines and future directions. Curr.Opin Cardiol Jul;29(4): Intra-aortic balloon pump use in high-risk percutaneous coronary intervention. Curr.Opin Cardiol. 2013;28: 2004 ACC/AHA STEMI Guideline
Class I IABP should be used in STEMI patients with Hypotention.(B) IABP is recommended for STEMI patients with low-output state.(B) IABP is recommended for STEMI patients when cardiogenic shock is not quickly reversed with pharmacological therapy.(B) IABP should be used in addition to medical therapy for STEMI patients with recurrent ischemic-type chest discomfort and signs of hemodynamic instability,poor LV function, or a large area of myocardium at risk.(C) Class IIa It is reasonable to manage STEMI patients with refractory polymorphic VT with IABP to reduce myocardial ishemia.(B) Recent data for IABP Intra-aortic balloon pump: indications, efficacy, guidelines and future directions. Curr.Opin Cardiol Jul;29(4): IABP in AMI without shock
JAMA, September 28, 2011Vol 306, No. 12 IABP in MI without shock
Primary end pointinfarct sizep=0.06 Second end pointall-cause death at 6 months:p=0.12 no significant differences JAMA, September 28, 2011Vol 306, No. 12 IABP in MI without shock
European Heart Journal (2009) 30, 459468 Am Heart J Jul;164(1):58-65 IABP in MI without shock IABP in MI without shock
2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:Circulation 2013; 127:e362e425. ESC guidelines for the management of STEMI elevation.Eur Heart J 2012; 33:2569 IABP in cardiogenic shock
IABP-SHOCK II : the largest randomized control trial ever performed in cardiogenic shock - randomised 600 patients enrolled in 37 centres in Germany from June 2009 to March 2012 Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367: IABP-SHOCK II STUDY Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367: IABP-SHOCK II STUDY Primary Study Endpoint: 30-DAY Morality
Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367: IABP-SHOCK II STUDY Lancet.2013 Nov 16;382(9905): IABP-SHOCK II STUDY Conclusions
Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367: Lancet.2013 Nov 16;382(9905): IABP in cardiogenic shock
Am Heart J May;165(5): IABP in cardiogenic shock
Am Heart J May;165(5): IABP in cardiogenic shock
Am Heart J May;165(5): IABP in cardiogenic shock
Am Heart J May;165(5): European Heart Journal (2009) 30, 459468 IABP in cardiogenic shock
2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:Circulation 2013; 127:e362e425. 2014 ESC/EACTS guidelines on myocardial revascularization:European Heart J (2014)35; Ballon pump assited coronary intervention study(BCIS-1)
IABP in high-risk PCI Ballon pump assited coronary intervention study(BCIS-1) JAMA 2010,304(8): Ballon pump assited coronary intervention study(BCIS-1)
JAMA 2010,304(8): Ballon pump assited coronary intervention study(BCIS-1)
Major outcomes: MACCE MACCE 15.2% vs 16.0% p=0.85 Death:2.0% vs 0.7%, p=0.34 MI:12.6% vs 13.3%, p=0.85 Revasculatization: 0.7% vs 2.7%, p=0.21 Complications: 1.3% vs 10.7% p