Encouraging survival rates in patients with acute myocardial infarction treated with an intra-aortic balloon pump

• Published in: Netherlands heart journal Vol. 19; no. 3; pp. 112 - 118
• Main Authors: Valk, S. D. A., Cheng, J. M., den Uil, C. A., Lagrand, W. K., van der Ent, M., van de Sande, M., van Domburg, R. T., Simoons, M. L.
• Format: Journal Article
• Language: English
• Published: Heidelberg Bohn Stafleu van Loghum 01.03.2011
• Subjects: Cardiology; Medical Education; Medicine; Medicine & Public Health; Original; Original Article; Acute myocardial infarction; Survival; Outcome; Intra-aortic balloon pump; Predictors
• ISSN: 1568-5888; 1876-6250
• DOI: 10.1007/s12471-010-0066-0

Objective To evaluate a 30-day and long-term outcome of patients with acute myocardial infarction (AMI) treated with intra-aortic balloon pump (IABP) counterpulsation and to identify predictors of a 30-day and long-term all-cause mortality. Methods Retrospective cohort study of 437 consecutive AMI patients treated with IABP between January 1990 and June 2004. A Cox proportional hazards model was used to identify predictors of a 30-day and long-term all-cause mortality. Results Mean age of the study population was 61 ± 11 years, 80% of the patients were male, and 68% had cardiogenic shock. Survival until IABP removal after successful haemodynamic stabilisation was 78% ( n  = 341). Cumulative 30-day survival was 68%. Median follow-up was 2.9 years (range, 6 months to 15 years). In patients who survived until IABP removal, cumulative 1-, 5-, and 10-year survival was 75%, 61%, and 39%, respectively. Independent predictors of higher long-term mortality were prior cerebrovascular accident (hazard ratio (HR), 1.8; 95% confidence interval (CI), 1.0–3.4), need for antiarrhythmic drugs (HR, 2.3; 95% CI, 1.5–3.3), and need for renal replacement therapy (HR, 2.3; 95% CI, 1.2–4.3). Independent predictors of lower long-term mortality were primary percutaneous coronary intervention (PCI; HR, 0.6; 95% CI, 0.4–1.0), failed thrombolysis with rescue PCI (HR, 0.5; 95% CI, 0.3–0.9), and coronary artery bypass grafting (HR, 0.3; 95% CI, 0.1–0.5). Conclusions Despite high in-hospital mortality in patients with AMI treated with IABP, a favourable number of patients survived in the long-term. These results underscore the value of aggressive haemodynamic support of patients throughout the acute phase of AMI.