A randomized comparison of intra-aortic balloon pumping after primary coronary angioplasty in high risk patients with acute myocardial infarction

Aims Intra-aortic balloon pumping reduces afterload and may be effective in improving reperfusion in high risk infarct patients treated with primary angioplasty. Methods High risk infarct patients referred from other centres for primary PTCA were randomized to treatment with or without an intra-aort...

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Veröffentlicht in:European heart journal 1999-05, Vol.20 (9), p.659-665
Hauptverfasser: van ‘t Hof, A.W.J., Liem, A.L., de Boer, M.J., Hoorntje, J.C.A., Suryapranata, H., Zijlstra, F.
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container_end_page 665
container_issue 9
container_start_page 659
container_title European heart journal
container_volume 20
creator van ‘t Hof, A.W.J.
Liem, A.L.
de Boer, M.J.
Hoorntje, J.C.A.
Suryapranata, H.
Zijlstra, F.
description Aims Intra-aortic balloon pumping reduces afterload and may be effective in improving reperfusion in high risk infarct patients treated with primary angioplasty. Methods High risk infarct patients referred from other centres for primary PTCA were randomized to treatment with or without an intra-aortic balloon pump. The primary end-point consisted of the combination of death, non-fatal reinfarction, stroke or an ejection fraction
doi_str_mv 10.1053/euhj.1998.1348
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Methods High risk infarct patients referred from other centres for primary PTCA were randomized to treatment with or without an intra-aortic balloon pump. The primary end-point consisted of the combination of death, non-fatal reinfarction, stroke or an ejection fraction &lt;30% at the 6 month follow-up. A weighted unsatisfactory outcome score (as previously described by Braunwald), enzymatic infarct size and left ventricular ejection fraction were secondary end-points. Results During a 3·5 year period, 238 patients were randomized, 118 to intra-aortic balloon pump therapy and 120 to no intra-aortic balloon pump therapy. Cross-over (25% in the intra-aortic balloon pump group and 31% in the no-intra-aortic balloon pump group) occurred in both treatment arms. The primary end-point was reached in 31 (26%) patients assigned to an intra-aortic balloon pump and in 31 (26%) assigned to no intra-aortic balloon pump (P=0·94). Enzymatic infarct size (LDHQ72) was calculated in 163 (68%) patients and was not significantly different between either group (intra-aortic balloon pump: 1616±1148, no intra-aortic balloon pump: 1608±1163). The left ventricular ejection fraction was measured at the 6 month follow-up in 168 patients (80% of patients alive). No difference in ejection fraction was found in either group (intra-aortic balloon pump: 42±13%, no intra-aortic balloon pump: 40±14%,P=0·51). Major complications occurred in 8% of patients treated with an intra-aortic balloon pump. Conclusion Systematic use of intra-aortic balloon pumping after primary angioplasty does not lead to myocardial salvage or to a better clinical outcome in high-risk infarct patients. Use of intra-aortic balloon pumping after primary PTCA for acute myocardial infarction should be reserved for patients with severe haemodynamic compromise.</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1053/euhj.1998.1348</identifier><identifier>PMID: 10208786</identifier><language>eng</language><publisher>Oxford: Oxford University Press</publisher><subject>Aged ; Angioplasty, Balloon, Coronary ; Biological and medical sciences ; Cardiology. Vascular system ; Coronary heart disease ; Female ; Heart ; Humans ; Intra-Aortic Balloon Pumping ; L-Lactate Dehydrogenase - blood ; Male ; Medical sciences ; Middle Aged ; Myocardial infarction ; Myocardial Infarction - therapy ; primary PTCA ; Risk Factors ; Stroke Volume ; Treatment Outcome</subject><ispartof>European heart journal, 1999-05, Vol.20 (9), p.659-665</ispartof><rights>1999 INIST-CNRS</rights><rights>Copyright 1999 The European Society of Cardiology.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c398t-f657f80743c11b15499a521026b5097d71add536355043be4d4f1a452db3b69d3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27933,27934</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=1769777$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10208786$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van ‘t Hof, A.W.J.</creatorcontrib><creatorcontrib>Liem, A.L.</creatorcontrib><creatorcontrib>de Boer, M.J.</creatorcontrib><creatorcontrib>Hoorntje, J.C.A.</creatorcontrib><creatorcontrib>Suryapranata, H.</creatorcontrib><creatorcontrib>Zijlstra, F.</creatorcontrib><title>A randomized comparison of intra-aortic balloon pumping after primary coronary angioplasty in high risk patients with acute myocardial infarction</title><title>European heart journal</title><addtitle>Eur Heart J</addtitle><description>Aims Intra-aortic balloon pumping reduces afterload and may be effective in improving reperfusion in high risk infarct patients treated with primary angioplasty. Methods High risk infarct patients referred from other centres for primary PTCA were randomized to treatment with or without an intra-aortic balloon pump. The primary end-point consisted of the combination of death, non-fatal reinfarction, stroke or an ejection fraction &lt;30% at the 6 month follow-up. A weighted unsatisfactory outcome score (as previously described by Braunwald), enzymatic infarct size and left ventricular ejection fraction were secondary end-points. Results During a 3·5 year period, 238 patients were randomized, 118 to intra-aortic balloon pump therapy and 120 to no intra-aortic balloon pump therapy. Cross-over (25% in the intra-aortic balloon pump group and 31% in the no-intra-aortic balloon pump group) occurred in both treatment arms. The primary end-point was reached in 31 (26%) patients assigned to an intra-aortic balloon pump and in 31 (26%) assigned to no intra-aortic balloon pump (P=0·94). Enzymatic infarct size (LDHQ72) was calculated in 163 (68%) patients and was not significantly different between either group (intra-aortic balloon pump: 1616±1148, no intra-aortic balloon pump: 1608±1163). The left ventricular ejection fraction was measured at the 6 month follow-up in 168 patients (80% of patients alive). No difference in ejection fraction was found in either group (intra-aortic balloon pump: 42±13%, no intra-aortic balloon pump: 40±14%,P=0·51). Major complications occurred in 8% of patients treated with an intra-aortic balloon pump. Conclusion Systematic use of intra-aortic balloon pumping after primary angioplasty does not lead to myocardial salvage or to a better clinical outcome in high-risk infarct patients. Use of intra-aortic balloon pumping after primary PTCA for acute myocardial infarction should be reserved for patients with severe haemodynamic compromise.</description><subject>Aged</subject><subject>Angioplasty, Balloon, Coronary</subject><subject>Biological and medical sciences</subject><subject>Cardiology. Vascular system</subject><subject>Coronary heart disease</subject><subject>Female</subject><subject>Heart</subject><subject>Humans</subject><subject>Intra-Aortic Balloon Pumping</subject><subject>L-Lactate Dehydrogenase - blood</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial infarction</subject><subject>Myocardial Infarction - therapy</subject><subject>primary PTCA</subject><subject>Risk Factors</subject><subject>Stroke Volume</subject><subject>Treatment Outcome</subject><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpNkUFvFCEYhonR2LV69Wg4GG-zwjDAcKyb2hqbeFCTphfyDTC7tDPDCEx0-y_8x7LZjXqCwPO-5ONB6DUla0o4e--W3f2aKtWuKWvaJ2hFeV1XSjT8KVoRqnglRHt7hl6kdE8IaQUVz9EZJTVpZStW6PcFjjDZMPpHZ7EJ4wzRpzDh0GM_5QgVhJi9wR0MQyjn8zLOftpi6LOLeI5-hLgvwRimwwamrQ_zACnvSx7v_HaHS-EDniF7N-WEf_q8w2CW7PC4Dwai9TAUtodosg_TS_SshyG5V6f1HH3_ePltc13dfLn6tLm4qQxTba56wWXfEtkwQ2lHeaMU8LoMJjpOlLSSgrWcCcY5aVjnGtv0FBpe2451Qll2jt4de-cYfiwuZT36ZNwwwOTCkrRQktQtZQVcH0ETQ0rR9fo0taZEHyTogwR9kKAPEkrgzal56UZn_8OPv16AtycAkoGhLwaMT_84Wd6WsmDVEfMpu19_ryE-aCGZ5Pr69k5_be4-8Hqj9Gf2B9xaojc</recordid><startdate>19990501</startdate><enddate>19990501</enddate><creator>van ‘t Hof, A.W.J.</creator><creator>Liem, A.L.</creator><creator>de Boer, M.J.</creator><creator>Hoorntje, J.C.A.</creator><creator>Suryapranata, H.</creator><creator>Zijlstra, F.</creator><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19990501</creationdate><title>A randomized comparison of intra-aortic balloon pumping after primary coronary angioplasty in high risk patients with acute myocardial infarction</title><author>van ‘t Hof, A.W.J. ; Liem, A.L. ; de Boer, M.J. ; Hoorntje, J.C.A. ; Suryapranata, H. ; Zijlstra, F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c398t-f657f80743c11b15499a521026b5097d71add536355043be4d4f1a452db3b69d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Angioplasty, Balloon, Coronary</topic><topic>Biological and medical sciences</topic><topic>Cardiology. Vascular system</topic><topic>Coronary heart disease</topic><topic>Female</topic><topic>Heart</topic><topic>Humans</topic><topic>Intra-Aortic Balloon Pumping</topic><topic>L-Lactate Dehydrogenase - blood</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial infarction</topic><topic>Myocardial Infarction - therapy</topic><topic>primary PTCA</topic><topic>Risk Factors</topic><topic>Stroke Volume</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van ‘t Hof, A.W.J.</creatorcontrib><creatorcontrib>Liem, A.L.</creatorcontrib><creatorcontrib>de Boer, M.J.</creatorcontrib><creatorcontrib>Hoorntje, J.C.A.</creatorcontrib><creatorcontrib>Suryapranata, H.</creatorcontrib><creatorcontrib>Zijlstra, F.</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van ‘t Hof, A.W.J.</au><au>Liem, A.L.</au><au>de Boer, M.J.</au><au>Hoorntje, J.C.A.</au><au>Suryapranata, H.</au><au>Zijlstra, F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A randomized comparison of intra-aortic balloon pumping after primary coronary angioplasty in high risk patients with acute myocardial infarction</atitle><jtitle>European heart journal</jtitle><addtitle>Eur Heart J</addtitle><date>1999-05-01</date><risdate>1999</risdate><volume>20</volume><issue>9</issue><spage>659</spage><epage>665</epage><pages>659-665</pages><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Aims Intra-aortic balloon pumping reduces afterload and may be effective in improving reperfusion in high risk infarct patients treated with primary angioplasty. Methods High risk infarct patients referred from other centres for primary PTCA were randomized to treatment with or without an intra-aortic balloon pump. The primary end-point consisted of the combination of death, non-fatal reinfarction, stroke or an ejection fraction &lt;30% at the 6 month follow-up. A weighted unsatisfactory outcome score (as previously described by Braunwald), enzymatic infarct size and left ventricular ejection fraction were secondary end-points. Results During a 3·5 year period, 238 patients were randomized, 118 to intra-aortic balloon pump therapy and 120 to no intra-aortic balloon pump therapy. Cross-over (25% in the intra-aortic balloon pump group and 31% in the no-intra-aortic balloon pump group) occurred in both treatment arms. The primary end-point was reached in 31 (26%) patients assigned to an intra-aortic balloon pump and in 31 (26%) assigned to no intra-aortic balloon pump (P=0·94). Enzymatic infarct size (LDHQ72) was calculated in 163 (68%) patients and was not significantly different between either group (intra-aortic balloon pump: 1616±1148, no intra-aortic balloon pump: 1608±1163). The left ventricular ejection fraction was measured at the 6 month follow-up in 168 patients (80% of patients alive). No difference in ejection fraction was found in either group (intra-aortic balloon pump: 42±13%, no intra-aortic balloon pump: 40±14%,P=0·51). Major complications occurred in 8% of patients treated with an intra-aortic balloon pump. Conclusion Systematic use of intra-aortic balloon pumping after primary angioplasty does not lead to myocardial salvage or to a better clinical outcome in high-risk infarct patients. Use of intra-aortic balloon pumping after primary PTCA for acute myocardial infarction should be reserved for patients with severe haemodynamic compromise.</abstract><cop>Oxford</cop><pub>Oxford University Press</pub><pmid>10208786</pmid><doi>10.1053/euhj.1998.1348</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record>
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subjects Aged
Angioplasty, Balloon, Coronary
Biological and medical sciences
Cardiology. Vascular system
Coronary heart disease
Female
Heart
Humans
Intra-Aortic Balloon Pumping
L-Lactate Dehydrogenase - blood
Male
Medical sciences
Middle Aged
Myocardial infarction
Myocardial Infarction - therapy
primary PTCA
Risk Factors
Stroke Volume
Treatment Outcome
title A randomized comparison of intra-aortic balloon pumping after primary coronary angioplasty in high risk patients with acute myocardial infarction
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