Pump Placed in Aorta Doesn't Improve Angioplasty Outcomes: Study
TUESDAY Aug. 24, 2010 -- Patients who chose to have a special pump placed in their heart's aorta before undergoing procedures to open blocked arteries didn't have improved outcomes, new research shows.
The British study included patients undergoing percutaneous coronary intervention (PCI), which includes balloon angioplasty and/or stent placement to open narrowed coronary arteries. The patients had poor left ventricular function and extensive coronary disease, which put them at increased risk for ischemia (restricted blood flow) or arrhythmia (irregular heartbeat) during the procedure.
In these high-risk cases, an intra-aortic balloon pump (IABP) is an option. The pump is connected to a balloon-type device that is inserted into the descending aorta.
The study findings are published in the Aug. 25 issue of the Journal of the American Medical Association.
"Observational studies have previously reported that elective IABP insertion may improve outcomes following high-risk PCI. To date, this assertion has not been tested in a randomized trial," study author Dr. Divaka Perera, of King's College London, and colleagues said in a news release from the journal's publisher.
The study included 301 patients. Some opted for IABP insertion while others decided against it. The primary outcome, which is a measurement used to determine the effect of the intervention, was the occurrence of a major adverse cardiac and cardiovascular event (MACCE). MACCE is defined as death, heart attack, cerebrovascular event or further revascularization at hospital discharge [up to 28 days]).
MACCE at hospital discharge occurred in 15.2 percent of the patients in the pump group and 16 percent of the no-pump group. The all-cause death rate six months after hospital discharged was 4.6 percent in the pump group and 7.4 percent in the no-pump group.
"The study did not demonstrate a difference in MACCE at hospital discharge and therefore does not support routine elective IABP insertion before high-risk PCI. However, 12 percent of patients who underwent PCI without elective IABP insertion required rescue IABP support, which highlights the importance of adopting a standby IABP strategy when undertaking high-risk PCI," the researchers concluded.
Posted: August 2010