Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
JACC Cardiovasc Interv. 2012 Mar;5(3):350-7. doi: 10.1016/j.jcin.2011.12.012.
This study aims to report a "real-world" experience of in hospital complications and clinical outcome of a large cohort of consecutive patients who underwent percutaneous coronary intervention (PCI) with intra-aortic balloon pump counterpulsation (IABP) support, from a tertiary care center over a 12-year period.
The incidence of vascular complications in patients treated with PCI and IABP is expected to be higher due to simultaneous puncture of femoral arteries, larger IABP sheath size, and longer duration of IABP therapy.
A total of 360 consecutive patients (mean age of 65.9 ± 11.2 years; 80.6% male) who required an IABP support during percutaneous PCI were classified into 3 groups: Urgent: 133 patients (36.9%) admitted with acute coronary syndrome in whom IABP therapy was started before urgent PCI; Emergent: 56 patients (15.6%) in whom emergent IABP insertion was required to manage hypotension during PCI; and Elective: 171 patients (47.5%) with stable angina pectoris in whom IABP was inserted before elective PCI. Overall bleeding was defined according to the newest the Bleeding Academic Research Consortium (BARC) definition criteria.
BARC bleeding occurred in 68 patients (19%), with the highest incidence noted in the Urgent group (31.1%), in comparison with the Emergent (26.8%) and Elective (7%) groups, p < 0.0001. Bleeding related to the IABP access site was 7.5%, which accounted for 82% of any access site-related bleeding. It was significantly higher in the Urgent group (12.8%) compared with the Elective (4.1%) and Emergent (5.4%) groups. At multivariate analysis, IABP treatment duration and renal impairment were the only independent predictors of BARC bleeding.
Bleeding related to the IABP access site was significantly higher in the Urgent group and accounted for more than two-thirds of overall access site-related bleeding. IABP treatment duration and renal impairment were independent predictors of overall bleeding.
本研究旨在报告一项来自三级护理中心的、长达 12 年的连续患者队列的院内并发症和临床结果的真实世界经验，这些患者在经皮冠状动脉介入治疗（PCI）期间接受了主动脉内球囊反搏（IABP）支持。
由于股动脉同时穿刺、IABP 鞘管尺寸较大以及 IABP 治疗时间较长，接受 PCI 和 IABP 治疗的患者发生血管并发症的发生率预计会更高。
总共纳入了 360 例连续患者（平均年龄 65.9±11.2 岁；80.6%为男性），这些患者在经皮 PCI 期间需要 IABP 支持，他们被分为 3 组：紧急组：133 例（36.9%）患者因急性冠状动脉综合征入院，在紧急 PCI 前开始 IABP 治疗；紧急组：56 例（15.6%）患者在 PCI 期间需要紧急插入 IABP 以治疗低血压；择期组：171 例（47.5%）稳定性心绞痛患者在择期 PCI 前插入 IABP。根据最新的出血学术研究联合会（BARC）定义标准定义总体出血情况。
68 例患者（19%）发生 BARC 出血，其中紧急组发生率最高（31.1%），与紧急组（26.8%）和择期组（7%）相比，p<0.0001。与 IABP 入路部位相关的出血发生率为 7.5%，占所有入路部位相关出血的 82%。在紧急组（12.8%）显著高于择期组（4.1%）和紧急组（5.4%）。多变量分析显示，IABP 治疗时间和肾功能不全是 BARC 出血的唯一独立预测因素。
紧急组 IABP 入路部位相关出血显著较高，占总体入路部位相关出血的三分之二以上。IABP 治疗时间和肾功能不全是总体出血的独立预测因素。
