The preoperative intraaortic balloon pump in coronary bypass surgery: A lack of evidence of effectiveness - 21/08/11
, Gerald T. O'Connor, PhD b, c, Gregory M. Hirsch, MD a, William A. Ghali, MD d, Kathryn A. Sabadosa, MPH b, c, Jeremy R. Morton, MD e, f, Cathy S. Ross, MS b, c, Felix Hernandez, MD g, William C. Nugent, MD h, Stephen J. Lahey, MD i, Donato Sisto, MD j, Lawrence J. Dacey, MD h, John D. Klemperer, MD g, Robert E. Helm, MD j, Andrew Maitland, MD kRésumé |
Background |
There is limited evidence demonstrating the effectiveness of preoperative intraaortic balloon pump (IABP) use in isolated coronary artery bypass graft (CABG) surgery. A single-center randomized trial demonstrated its benefit. We undertook a multicenter observational study to verify this finding.
Methods |
In 29950 consecutive patients undergoing isolated CABG between 1995 and 2000 at 10 centers, we compared patients with and without a preoperative IABP. We also compared the effect of preoperative IABP use within 7 high-risk clinical subgroups. To validate the previous randomized trial, patients with any 2 of the following were also analyzed: left main >70%, ejection fraction <40%, redo CABG, or preoperative intravenous nitroglycerin.
Results |
Preoperative IABPs were used in 1896 patients (6.3%). These patients had more comorbid conditions and a higher crude mortality than those who did not have preoperative IABPs (9.5% vs 2.3%, P < .0001). Preoperative IABP patients were caliper matched to non–preoperative IABP patients using a propensity score. Excess mortality associated with preoperative IABP persisted (9.2% vs 5.8%, P = .0004). In 7 high-risk subgroups, mortality was significantly higher with preoperative IABP. We used propensity caliper matching to compare preoperative IABP with non–preoperative IABP patients who met trial criteria (n = 4332). Preoperative IABP was associated with higher mortality (11.0% vs 6.5%, P = .0009). Removing emergency patients did not alter results.
Conclusions |
Use of preoperative IABPs was consistently associated with higher mortality. Despite detailed statistical analysis, we were unable to show benefit from preoperative IABP use or confirm the results of a single-center trial that demonstrated its benefit. Assessment of preoperative IABP efficacy will require a randomized trial.
Le texte complet de cet article est disponible en PDF.Plan
Vol 150 - N° 6
P. 1122-1127 - décembre 2005 Retour au numéro
Article précédent
- Predictors of a sustained response to exercise training in patients with chronic heart failure: A telemonitoring study
- Neil Smart, Brian Haluska, Leanne Jeffriess, Thomas H. Marwick
- Independent elevations of N-terminal pro–brain natriuretic peptide and cardiac troponins in endurance athletes after prolonged strenuous exercise
- Jürgen Scharhag, Markus Herrmann, Axel Urhausen, Michaela Haschke, Wolfgang Herrmann, Wilfried Kindermann
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?