Su Dan, Yan Bin, Guo Litao, Peng Liyuan, Wang Xue, Zeng Lingfang, Ong HeanYee, Wang Gang
From the Departments of Cardiology (DS) and Emergency Medicine (BY, LP, GW), the Second Affiliated Hospital; Intensive Care Unit, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China (LG, XW); Cardiovascular Division, King's College London, British Heart Foundation Centre, London, United Kingdom (LZ); and Department of Cardiology, Khoo Teck Puat Hospital, Singapore (HYO).
Medicine (Baltimore). 2015 May;94(19):e876. doi: 10.1097/MD.0000000000000876.
Intra-aortic balloon pump (IABP) has been extensively used in clinical practice as a circulatory-assist device. However, current literature demonstrated significantly varied indications for IABP application and prognosis.The objective of the study was to assess the potential benefits or risks of IABP treatment for acute myocardial infarction (AMI) complicated with or without cardiogenic shock.MEDLINE and EMBASE database were systematically searched until November 2014, using the terms as follows: IABP, IABC (intra-aortic balloon counterpulsation), AMI, heart infarction, coronary artery disease, ischemic heart disease, and acute coronary syndrome. Only randomized controlled trials (RCTs) that compared the use of IABP or non-IABP support in AMI with or without cardiogenic shock were included. Two researchers performed data extraction independently, and at the mean time, the risk of bias among those RCTs was also assessed.Of 3026 citations, 17 studies (n = 3226) met the inclusion criteria. There is no significant difference between IABP group and control group on the short-term mortality (relative risk [RR], 0.90; 95% confidence interval [CI], 0.77-1.06; P = 0.214) and long-term mortality (RR, 0.91; 95% CI, 0.79-1.04; P = 0.155) in AMI patients with or without cardiogenic shock. These results were consistent when the analysis was performed on studies that only included patients with cardiogenic shock, both on short-term mortality (RR, 0.91; 95% CI, 0.77-1.08; P = 0.293) and long-term mortality (RR, 0.95; 95% CI, 0.83-1.10; P = 0.492). Similar result was also observed in AMI patients without cardiogenic shock. Furthermore, the risks of hemorrhage (RR, 1.49; 95% CI, 1.09-2.04; P = 0.013) and recurrent ischemia (RR 0.54, 95% CI 0.37 to 0.79; P = 0.002) were significantly higher in IABP group compared with control group.We did not observe substantial benefit from IABP application in reducing the short- and long-term mortality, while it might promote the risks of hemorrhage and recurrent ischemia. Therefore, IABP may be not an optimal therapy in AMI with or without cardiogenic shock until more elaborate classification is used for selecting appropriate patients.
主动脉内球囊反搏（IABP）作为一种循环辅助装置已在临床实践中广泛应用。然而，目前的文献表明IABP应用的适应证和预后存在显著差异。本研究的目的是评估IABP治疗急性心肌梗死（AMI）合并或不合并心源性休克的潜在益处或风险。系统检索MEDLINE和EMBASE数据库至2014年11月，使用以下检索词：IABP、IABC（主动脉内球囊反搏）、AMI、心肌梗死、冠状动脉疾病、缺血性心脏病和急性冠状动脉综合征。仅纳入比较IABP或非IABP支持在合并或不合并心源性休克的AMI患者中应用的随机对照试验（RCT）。两名研究人员独立进行数据提取，同时评估这些RCT中的偏倚风险。在3026条文献中，17项研究（n = 3226）符合纳入标准。在合并或不合并心源性休克的AMI患者中，IABP组与对照组在短期死亡率（相对风险[RR]，0.90；95%置信区间[CI]，0.77 - 1.06；P = 0.214）和长期死亡率（RR，0.91；95% CI，0.79 - 1.04；P = 0.155）方面无显著差异。当仅对纳入心源性休克患者的研究进行分析时，短期死亡率（RR，0.91；95% CI，0.77 - 1.08；P = 0.293）和长期死亡率（RR，0.95；95% CI，0.83 - 1.10；P = 0.492）方面结果相似。在不合并心源性休克的AMI患者中也观察到类似结果。此外，IABP组出血风险（RR，1.49；95% CI，1.09 - 2.04；P = 0.013）和再发缺血风险（RR 0.54，95% CI 0.37至0.79；P = 0.002）显著高于对照组。我们未观察到IABP应用在降低短期和长期死亡率方面有实质性益处，而它可能增加出血和再发缺血风险。因此，在使用更精细的分类方法选择合适患者之前，IABP可能不是合并或不合并心源性休克的AMI的最佳治疗方法。
