IABP用于高危PCI有价值吗? Is IABP Valuable for High-Risk PCI? 刘斌 吉林大学第二医院心血管医院

Physiological basis of IABP Intra-aortic balloon pump: indications, efficacy, guidelines and future directions. Curr.Opin Cardiol. 2014 Jul;29(4):285-92.

IABP for High-Risk PCI High-risk PCI: impaired left ventricular function significant ischemia risk in a large fraction of the myocardium impending hemodynamic instability acute myocardial infarction(AMI) Routine indications of IABP for high-risk PCI: cardiogenic shock ST-segment elevation myocardial infarction(STEMI) other high-risk situations Intra-aortic balloon pump: indications, efficacy, guidelines and future directions. Curr.Opin Cardiol. 2014 Jul;29(4):285-92. Intra-aortic balloon pump use in high-risk percutaneous coronary intervention. Curr.Opin Cardiol. 2013;28:671-675.

2004 ACC/AHA STEMI Guideline Class I IABP should be used in STEMI patients with Hypotention.(B) IABP is recommended for STEMI patients with low-output state.(B) IABP is recommended for STEMI patients when cardiogenic shock is not quickly reversed with pharmacological therapy.(B) IABP should be used in addition to medical therapy for STEMI patients with recurrent ischemic-type chest discomfort and signs of hemodynamic instability,poor LV function, or a large area of myocardium at risk.(C) Class IIa It is reasonable to manage STEMI patients with refractory polymorphic VT with IABP to reduce myocardial ishemia.(B)

Recent data for IABP Intra-aortic balloon pump: indications, efficacy, guidelines and future directions. Curr.Opin Cardiol. 2014 Jul;29(4):285-92.

IABP in AMI without shock JAMA, September 28, 2011—Vol 306, No. 12

IABP in MI without shock Primary end point：infarct size：p=0.06 Second end point：all-cause death at 6 months:p=0.12 no significant differences JAMA, September 28, 2011—Vol 306, No. 12

IABP in MI without shock European Heart Journal (2009) 30, 459–468 Am Heart J. 2012 Jul;164(1):58-65

IABP in MI without shock

IABP in MI without shock 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:Circulation 2013; 127:e362–e425. ESC guidelines for the management of STEMI elevation.Eur Heart J 2012; 33:2569–2619.29.

IABP in cardiogenic shock IABP-SHOCK II : the largest randomized control trial ever performed in cardiogenic shock - randomised 600 patients enrolled in 37 centres in Germany from June 2009 to March 2012 Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367:1287-1296.

IABP-SHOCK II STUDY Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367:1287-1296.

IABP-SHOCK II STUDY Primary Study Endpoint: 30-DAY Morality Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367:1287-1296.

IABP-SHOCK II STUDY Lancet.2013 Nov 16;382(9905):1638-45.

IABP-SHOCK II STUDY Conclusions： Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367:1287-1296. Lancet.2013 Nov 16;382(9905):1638-45.

IABP in cardiogenic shock Am Heart J. 2013 May;165(5):679-92.

IABP in cardiogenic shock Am Heart J. 2013 May;165(5):679-92.

IABP in cardiogenic shock Am Heart J. 2013 May;165(5):679-92.

IABP in cardiogenic shock Am Heart J. 2013 May;165(5):679-92.

European Heart Journal (2009) 30, 459–468

IABP in cardiogenic shock 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:Circulation 2013; 127:e362–e425. 2014 ESC/EACTS guidelines on myocardial revascularization:European Heart J (2014)35;2541-2619

Ballon pump assited coronary intervention study(BCIS-1) IABP in high-risk PCI Ballon pump assited coronary intervention study(BCIS-1) JAMA 2010,304(8):867-874

Ballon pump assited coronary intervention study(BCIS-1) JAMA 2010,304(8):867-874

Ballon pump assited coronary intervention study(BCIS-1) Major outcomes: MACCE MACCE： 15.2% vs 16.0% p=0.85 Death:2.0% vs 0.7%, p=0.34 MI:12.6% vs 13.3%, p=0.85 Revasculatization: 0.7% vs 2.7%, p=0.21 Complications: 1.3% vs 10.7% p<0.001 JAMA 2010,304(8):867-874

Ballon pump assited coronary intervention study(BCIS-1) Secondary outcomes:6 month motality P=0.32 JAMA 2010,304(8):867-874

IABP in high-risk PCI . Lack of intra-aortic balloon pump effectiveness in high-risk percutaneous coronary interventions without cardiogenic shock: a comprehensive meta-analysis of randomised trials andobservational studies. Int J Cardiol 2013; 167:1783–1793.

. Lack of intra-aortic balloon pump effectiveness in high-risk percutaneous coronary interventions without cardiogenic shock: a comprehensive meta-analysis of randomised trials andobservational studies. Int J Cardiol 2013; 167:1783–1793.

IABP in high-risk PCI . Lack of intra-aortic balloon pump effectiveness in high-risk percutaneous coronary interventions without cardiogenic shock: a comprehensive meta-analysis of randomised trials andobservational studies. Int J Cardiol 2013; 167:1783–1793.

IABP in high-risk PCI 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:Circulation 2013; 127:e362–e425. ESC guidelines for the management of STEMI elevation.Eur Heart J 2012; 33:2569–2619.29.

limititions Lower mortality rates were observed than reported in previous registries. Cross-over rates between groups are high in all trials. Data remains to be conflicting. The longer-term follow-up from the BCIS-1 trial showed a significant reduction in all-cause mortality among IABP group,the mechanism of this benefit is still unclear.

SUMMARY The recent 3 major trials (CRISP-AMI, IABP-SHOCK II, BCIS-1) and all meta-analyses evaluating the routine use of IABP in different high-risk situations failed to show evidence of efficacy. All these trials did establish the safety of IABP in high-risk patients without any increased vascular or bleeding complications even in emergency situations such as AMI. The usage of IABP in high-risk PCI sould be more careful, selective and individualized. Larger RCTs with long-term follow-up and a better understanding of physiological aspects of IABP are still to be demanded.

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