Key result
Intra-aortic balloon pump during PCI did not significantly reduce overall mortality, but lowered 30-day mortality in AMI patients without cardiogenic shock (OR 0.35, p=0.015).
Why the study?
Does intra-aortic balloon pump (IABP) reduce mortality in adult patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction?
Meta-Analysis
Does intra-aortic balloon pump (IABP) reduce mortality in adult patients undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction?
Routine use of IABP does not improve 30-day or 6-month mortality in patients undergoing PCI for AMI with cardiogenic shock or high-risk PCI, but may offer mortality benefits in AMI patients without cardiogenic shock.
Answers are grounded in this paper and cite their sources.
IABP lacks overall mortality benefit in AMI PCI; reinforces against routine use in shock while leaving non-shock subgroup benefit open for confirmation.
BACKGROUND: Conflicting reports on the efficacy of intra-aortic balloon pump (IABP) during percutaneous coronary intervention (PCI) incited us to evaluate the utility of IABP in patients with acute myocardial infarction (AMI). METHODS: Randomized clinical trials comparing patients, who received IABP vs. control (no IABP) during PCI, were hand-searched from MEDLINE, Cochrane, and EMBASE databases using the terms "intra-aortic balloon pump, percutaneous coronary intervention, myocardial infarction, acute coronary syndrome". Mortality rate (30-day and 6-month mortality) was the primary outcome, while the secondary outcomes included 30-day bleeding rate, reinfarction rate, revascularization rate and stroke rate. RESULTS: Pooled results of the seven trials identified indicated that the 30-day and 6-month mortality rate were not significantly different between the IABP and control groups. However, in patients with MI, but without cardiogenic shock (CS), IABP was associated with lower odds of 30-day mortality (OR = 0.35, p = 0.015) and 6-month mortality (OR = 0.41, p = 0.020). The pooled results of 30-day bleeding rate was not significantly higher in patients with IABP than the control group, but for the patients with high risk PCI without CS, it was higher in patients with IABP than the control group (OR = 1.58, p = 0.009). The re-infarction, revascularization, and the stroke rate at 30 days of follow-up were not significantly different between the two groups. CONCLUSIONS: The present results do not favor the clinical utility of IABP in patients suffering high-risk PCI without CS and AMI complicated with CS. However, in patients with AMI, but without CS, IABP may reduce the 30-day and 6-month mortality rate.
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Zheng et al. (2016) conducted a meta-analysis in acute myocardial infarction (AMI). Intra-aortic balloon pump (IABP) vs. Control (no IABP) was evaluated on 30-day and 6-month mortality. Intra-aortic balloon pump during PCI did not significantly reduce overall mortality, but lowered 30-day mortality in AMI patients without cardiogenic shock (OR 0.35, p=0.015).
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