Clinical characteristics and outcomes after unplanned intraaortic balloon counterpulsation in the Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction trial - 18/03/16

Doi : 10.1016/j.ahj.2015.12.004

Louis P. Kohl, MD ^a, Jeffrey D. Leimberger, PhD ^b, Karen Chiswell, PhD ^b, W. Schuyler Jones, MD ^b,^c, Holger Thiele, MD ^d, Richard W. Smalling, MD, PhD ^e, Praveen Chandra, MD ^f, Marc Cohen, MD ^g, Divaka Perera, MD ^h, Derek P. Chew, MBBS, MPH ⁱ, John K. French, MBChB, PhD ^j, Jonathan Blaxil, MD ^k, A. Sreenivas Kumar, MD, DM ^l, E. Magnus Ohman, MD ^b,^c, Manesh R. Patel, MD ^b,^c,^{^⁎}
^a Division of Cardiology, Hennepin County Medical Center, Minneapolis, MN
^b Duke Clinical Research Institute, Durham, NC
^c Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC
^d Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany
^e Division of Cardiology, Memorial Hermann Heart and Vascular Institute, University of Texas, Houston, TX
^f Division of Cardiology, Medanta–The Medicity, Haryana, India
^g Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ
^h Cardiovascular Division, King's College, London, UK
ⁱ Department of Cardiovascular Medicine, Flinders University, Bedford Park, Australia
^j Department of Cardiology, Liverpool Hospital, Liverpool, Australia
^k Department of Cardiology, Leeds General Infirmary, Leeds, UK
^l Citizens Hospital Nallagandla, Hyderabad, India

^⁎Reprint requests: Manesh R. Patel, MD, Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, 2400 Pratt St, Durham, NC 27715.Duke Clinical Research Institute, Duke University Medical CenterPO Box 17969, 2400 Pratt StDurhamNC27715

Résumé

Background

Despite advances in primary percutaneous coronary intervention (pPCI) and regional systems of care, the development of cardiogenic shock is associated with poor clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). We sought to better characterize the baseline characteristics and clinical outcomes of patients who underwent crossover to intraaortic balloon counterpulsation (IABC) in the CRISP AMI trial.

Methods

Patients with anterior STEMI were randomized to IABC before pPCI or pPCI alone. Infarct size and 6-month clinical outcomes were evaluated in patients both in the pPCI-alone group who did undergo crossover to IABC and those who did not undergo crossover to IABC.

Results

Among 176 patients randomized to pPCI alone, 161 patients did not later receive IABC during the index hospitalization, and 15 patients (8.5%) underwent crossover and did receive unplanned IABC. Hypotension and/or cardiogenic shock precipitated crossover to IABC in 12 patients (80%). Patients who underwent crossover to IABC demonstrated lower systolic and diastolic blood pressures on admission. At 6 months, rates of death (26.7% vs 3.1%, P = .003), readmission for severe hypotension (53.3% vs 3.7%, P < .001), resuscitated cardiac arrest, and ventricular arrhythmia were higher in the group that did crossover to IABC. Crossover to IABC was not associated with increased infarct size.

Conclusions

The most significant predictor of crossover to IABC in the setting of anterior STEMI was relative hypotension at the time of hospital admission, and crossover to IABC in CRISP AMI was associated with significantly worse clinical outcomes.

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Plan

Methods

Statistical analysis

Results

Baseline characteristics

Procedural characteristics

Cardiac magnetic resonance imaging findings

	William S. Weintraub, MD served as guest editor for this article.
	Clinical trial registration: RCT no. NCT00833612.

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Clinical characteristics and outcomes after unplanned intraaortic balloon counterpulsation in the Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction trial - 18/03/16

Résumé

Background

Methods

Results

Conclusions

Plan

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