Department of Cardiology, St Thomas' Hospital, London, UK.
Curr Opin Cardiol. 2013 Nov;28(6):671-5. doi: 10.1097/HCO.0b013e3283652dcc.
Despite the long-term availability and clinical usage of intraaortic balloon pump (IABP) counterpulsation, there is a paucity of randomized trial evidence for its use. Here, we will review the latest evidence for its usage in different clinical settings.
There have been decades of nonrandomized and observational data available, but only in the last 3 years has there been availability of randomized evidence for IABP use in acute myocardial infarction (AMI) with cardiogenic shock, ST elevation acute coronary syndromes (STE-ACS) without shock and high-risk percutaneous coronary intervention (PCI) cohorts.
To the surprise of many, despite the sound physiological benefits achieved by the use of IABP counterpulsation in these situations, all the recent trials did not achieve the primary endpoint, although there is a trend towards long-term benefit with its use. This may alter its elective use in practice and may lead to changes in current guidance and possibly increase the focus on other mechanical circulatory devices. Despite the neutral primary endpoints in these recent trials, there is a signal that a subset of the population may benefit by elective IABP use and get good haemodynamic support, thus suggesting, in our view, that further understanding and research are required to gain maximum physiological benefit from this device and to aid decision making for an individualized, patient-centred approach.
尽管主动脉内球囊反搏（IABP）的临床应用已有很长时间，但关于其使用的随机试验证据很少。在此，我们将回顾其在不同临床环境中的最新应用证据。
几十年来，已有大量非随机和观察性数据可用，但直到最近 3 年，才有关于 IABP 在伴心原性休克的急性心肌梗死（AMI）、无休克的 ST 段抬高急性冠脉综合征（STE-ACS）和高危经皮冠状动脉介入治疗（PCI）患者中的应用的随机证据。
令许多人惊讶的是，尽管在这些情况下使用 IABP 反搏可带来良好的生理益处，但最近所有的试验都没有达到主要终点，尽管其使用有长期获益的趋势。这可能会改变其在实践中的选择性应用，并可能导致对当前指南的修改，以及可能增加对其他机械循环支持装置的关注。尽管这些最近的试验主要终点为中性，但有信号表明，一部分人群可能通过选择性使用 IABP 获益并获得良好的血液动力学支持，因此，我们认为，需要进一步了解和研究，以从该设备中获得最大的生理益处，并为个体化、以患者为中心的方法做出决策。
