Key result
LAD disease linked to ~362% higher PMI risk in IABP patients during open heart surgery.
Why the study?
What are the risk factors for septicemia and perioperative myocardial infarction in patients receiving intra-aortic balloon pump support during open heart surgery?
Cohort (n=1,325)
What are the risk factors for septicemia and perioperative myocardial infarction in patients receiving intra-aortic balloon pump support during open heart surgery?
In patients requiring IABP during open heart surgery, LAD disease strongly predicts perioperative MI, while prolonged IABP duration and valve surgery increase the risk of septicemia, suggesting the need for early pump removal.
LAD disease may heighten perioperative MI vigilance in IABP patients; leaves open whether risk-stratified interventions improve outcomes.
In 1325 open heart operated (OHO) patients with a perioperative mortality of 5.8% the incidence of septicemia and perioperative myocardial infarction (PMI) were much higher in a cohort of 110 patients given intra-aortic balloon pump (IABP) support during the operative course. Analysis of this cohort showed that peri/postoperative insertion of the pump, the presence of disease in the descending branch of left coronary artery (LAD) and the need of more than one saphenous vein graft were risk factors for PMI. The presence of LAD disease was the only independent risk factor for PMI with an odds ratio (OR) of 4.62. Well known risk factors such as NYHA functional class, emergency, low left ventricular ejection fraction (EF) or elevated end diastolic pressure (EDP) were not prognostic of PMI. Thus, the intraoperative seemed to be more important than the preoperative risk profile for the development of PMI. Independent risk factors for the development of septicemia were the duration of IABP with an OR of 1.5 for each pump day and implantation of a valve prosthesis with an OR of 6.3. To avoid septic complications, this study suggests pump removal as soon as possible.
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Aksnes et al. (1993) conducted a cohort in Open heart surgery requiring intra-aortic balloon pump (IABP) support (n=1,325). LAD disease, IABP duration, and valve prosthesis implantation vs. Absence of risk factors was evaluated on Perioperative myocardial infarction (PMI) (OR 4.62). In patients receiving IABP during open heart surgery, LAD disease was an independent risk factor for perioperative myocardial infarction (OR 4.62).
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