Prophylactic IABP and PCPB support during high-risk PTCA yielded similar primary success rates (95% vs 95%), but PCPB had higher rates of vascular complications and blood transfusions.
RCT (n=40)
Does prophylactic intraaortic balloon pump (IABP) support improve safety and efficacy compared to percutaneous cardiopulmonary bypass (PCPB) support in high-risk patients undergoing PTCA?
In high-risk PTCA patients with severe LV dysfunction, prophylactic IABP and PCPB offer similar procedural success and mortality, but IABP is associated with significantly fewer vascular complications and bleeding events.
Absolute Event Rate: 95% vs 95%
Forty patients undergoing percutaneous transluminal coronary angioplasty (PTCA) with severely impaired left ventricular ejection fraction (LVEF) 50%) being perfused by the target vessel. The IABP and PCPB supported groups were comparable in LVEF (20% +/- 6.4% vs 22.8% +/- 8.1%), mean pulmonary artery pressure (46.5 +/- 10.5 mmHg vs 42.6 +/- 12.6 mmHg), average number of vessels dilated (1.4 vs 1.3), mean inflation time (2.8 +/- 0.3 min vs 3.1 +/- 0.5 min), and hospital stay after PTCA (5.6 +/- 1.2 days vs 5.2 +/- 1.4 days). The primary success rate (95% vs 95%) and hospital mortality (5% vs 5%) were also similar in the two groups. Two patients required surgical exploration of the femoral artery and eight patients required blood transfusion in the PCPB group. IABP patients had no vascular complications and did not require blood transfusion. High risk PTCA is equally effective whether using prophylactic IABP or PCPB support. PCPB support, however, has a higher rate of vascular complications and need for blood transfusions. IABP has the additional advantage of ease of insertion and the support can be used for a longer period after PTCA, if required.
Kaul et al. (1995) conducted an RCT in High-risk percutaneous transluminal coronary angioplasty (PTCA) with severely impaired LVEF (n=40). Prophylactic intraaortic balloon pump (IABP) support vs. Percutaneous cardiopulmonary bypass (PCPB) support was evaluated on Primary success rate. Prophylactic IABP and PCPB support during high-risk PTCA yielded similar primary success rates (95% vs 95%), but PCPB had higher rates of vascular complications and blood transfusions.