What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Acute myocardial infarction (n=17653). Intervention: Intra-aortic balloon pump (IABP) vs. No IABP. Primary outcome: Thirty-day mortality (OR 0.96, 95% CI 0.74-1.24).

What question did this study set out to answer?

To assess the efficacy of intra-aortic balloon pump (IABP) therapy in reducing 30-day mortality among patients with acute myocardial infarction.

March 30, 2015JAMA Internal Medicine

Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction

Q: What are the key findings of this study?

Intra-aortic balloon pump therapy did not significantly improve 30-day mortality among patients with acute myocardial infarction in randomized clinical trials (OR 0.96; 95% CI 0.74-1.24).

Q: What does this research mean for the field?

Intra-aortic balloon pump (IABP) therapy does not improve 30-day mortality in patients with acute myocardial infarction, regardless of whether they have cardiogenic shock. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

IABP shows no benefit for 30-day mortality in acute myocardial infarction.

OR 0.96
95% CI 0.74-1.24
n=17,653

Why the study?

Does intra-aortic balloon pump therapy reduce 30-day mortality in patients with acute myocardial infarction?

Population

17,653 patients with acute myocardial infarction, with or without cardiogenic shock

Comparison

Intra-aortic balloon pump (IABP) therapy vs No IABP

Design

Meta-analysis

Follow-up

30-day

Authors

YAYousif AhmadInterventional Cardiology SSSayan SenInterventional Cardiology MSMatthew Shun‐ShinCardiac Imaging

Discussion

Member takes

Implication

Does not support routine IABP use in AMI; challenges prior guideline recommendations for cardiogenic shock.

Key Points

To assess the efficacy of intra-aortic balloon pump (IABP) therapy in reducing 30-day mortality among patients with acute myocardial infarction.
Systematic review and random-effects meta-analysis of studies indexed in PubMed, Embase, and Cochrane libraries through December 2014 comparing IABP against no IABP in acute myocardial infarction.
Identified and analyzed 12 randomized clinical trials (N=2,123) and 15 observational studies (N=15,530), assessing RCT bias with the Cochrane risk of bias tool.
In the 12 RCTs, IABP use showed no statistically significant effect on 30-day mortality (OR, 0.96 [95% CI, 0.74-1.24]; I2 = 0%, P = .52).
Subgroup analyses by cardiogenic shock status showed consistent lack of mortality benefit both with shock (OR, 0.94 [95% CI, 0.69-1.28]; P = .69, I2 = 0%) and without shock (OR, 0.98 [95% CI, 0.57-1.69]; P = .95, I2 = 17%).
Observational studies yielded highly conflicting associations with mortality (OR, 0.96 [95% CI, 0.54-1.70]; I2 = 97%, P < .001), with baseline risk marker imbalance accounting for substantial heterogeneity (R2meta = 46.2%, P < .001).

Study Design

Type

Meta-Analysis (n=17,653)

Structured PICO

Does intra-aortic balloon pump therapy reduce 30-day mortality in patients with acute myocardial infarction?

Population

17,653 patients with acute myocardial infarction (2,123 from 12 RCTs and 15,530 from 15 observational studies), with or without cardiogenic shock

Intervention

Intra-aortic balloon pump (IABP) therapy

Comparator

No IABP

Outcome

30-day mortalityhard clinical

Main Result

Effect estimate: OR 0.96 (95% CI 0.74-1.24)

Intra-aortic balloon pump therapy does not improve 30-day mortality in patients with acute myocardial infarction, regardless of whether they have cardiogenic shock.

Limitations

Observational studies showed mutually contradictory associations due to differences in the balance of risk factors between groups.
High heterogeneity and mutually conflicting results in observational studies due to baseline risk marker imbalance

Cite This Study

Ahmad et al. (2015) conducted a meta-analysis in Acute myocardial infarction (n=17,653). Intra-aortic balloon pump (IABP) vs. No IABP was evaluated on Thirty-day mortality (OR 0.96, 95% CI 0.74-1.24). Intra-aortic balloon pump therapy did not significantly improve 30-day mortality among patients with acute myocardial infarction in randomized clinical trials (OR 0.96; 95% CI 0.74-1.24).

synapsesocial.com/papers/6a0a068d16dfdfe7ed348da0 https://doi.org/10.1001/jamainternmed.2015.0569

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Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Intra-aortic Balloon Pump Therapy for Acute Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Cite This Study

Also Consider

Also Consider