Departments of Medicine III Cardio-Thoracic-Surgery, Martin-Luther-University, Halle/Salle, Germany.
Artif Organs. 2012 Jun;36(6):505-11. doi: 10.1111/j.1525-1594.2011.01408.x. Epub 2012 May 21.
The European ST-elevated myocardial infarction (STEMI) guideline suggested the intra-aortic balloon pump (IABP) with a recommendation level I and a level of evidence C as an effective measure in combination with balloon angioplasty in patients with cardiogenic shock (CS), stent implantation, and inotropic and vasopressor support. Similarly, upon mechanical complication due to myocardial infarction (MI), the guideline suggests that in patients with a ventricular septal defect or in most patients with acute mitral regurgitation, preoperative IABP implantation is indicated for circulatory support. The American College of Cardiology/American Heart Association STEMI guideline recommends the use of the IABP with a recommendation level I and a level of evidence B if CS does not respond rapidly to pharmacological treatment. The guideline notes that the IABP is a stabilizing measure for angiography and early revascularization. Even in MI complications, the use of preoperative IABP is recommended before surgery. Within this overview, we summarize the current evidence on IABP use in patients with CS complicated by MI. From our Cochrane data analysis, we conclude that in CS due to acute MI (AMI) treated with adjuvant systemic fibrinolysis, the IABP should be implanted. In patients with CS following AMI, treated with primary percutaneous coronary intervention (PCI), the IABP can be implanted, although data are not distinctive (i.e., indicating positive and negative effects). In the future, randomized controlled trials are needed to determine the use of IABP in CS patients treated with PCI. When patients with CS are transferred to a PCI center with or without thrombolysis, patients should receive mechanical support with an IABP. To treat mechanical MI complications-in particular ventricular septal defect-patients should be treated with an IABP to stabilize their hemodynamic situation prior to cardiac surgery. Similar recommendations are given in the German Austrian guidelines on treatment of infarction-related CS patients (http://www.awmf.org/leitlinien/detail/ll/019-013.html).
欧洲 ST 段抬高型心肌梗死（STEMI）指南建议，在心脏性休克（CS）、支架植入、正性肌力和血管加压药物支持的患者中，将主动脉内球囊泵（IABP）与球囊血管成形术联合使用，作为一种有效的治疗手段，推荐等级为 I，证据水平为 C。同样，对于因心肌梗死（MI）引起的机械并发症，指南建议对于室间隔穿孔或大多数急性二尖瓣反流的患者，在术前应植入 IABP 以进行循环支持。美国心脏病学会/美国心脏协会 STEMI 指南建议，如果 CS 不能对药物治疗迅速做出反应，应使用 IABP，推荐等级为 I，证据水平为 B。该指南指出，IABP 是血管造影和早期血运重建的稳定措施。即使在 MI 并发症中，也建议在手术前使用术前 IABP。在这篇综述中，我们总结了目前关于 IABP 在 MI 合并 CS 患者中使用的证据。从我们的 Cochrane 数据分析中，我们得出结论，在接受辅助全身溶栓治疗的急性 MI（AMI）导致的 CS 患者中，应植入 IABP。对于接受直接经皮冠状动脉介入治疗（PCI）治疗的 AMI 后 CS 患者，可以植入 IABP，尽管数据没有明显的差异（即表明有积极和消极的影响）。未来需要进行随机对照试验来确定在接受 PCI 治疗的 CS 患者中使用 IABP。当 CS 患者被转移到接受或不接受溶栓治疗的 PCI 中心时，应使用 IABP 进行机械支持。为了治疗机械性 MI 并发症，特别是室间隔穿孔，应在心脏手术前使用 IABP 稳定患者的血液动力学情况。德国奥地利治疗与梗塞相关 CS 患者的指南（http://www.awmf.org/leitlinien/detail/ll/019-013.html）也给出了类似的建议。
