Fuernau Georg, Ledwoch Jakob, Desch Steffen, Eitel Ingo, Thelemann Nathalie, Jung Christian, de Waha-Thiele Suzanne, Pöss Janine, Feistritzer Hans-Josef, Freund Anne, Schneider Steffen, Ouarrak Taoufik, Werdan Karl, Zeymer Uwe, Thiele Holger
Medical Clinic II (Cardiology, Angiology, Intensive Care Medicine), University Heart Centre Lübeck, Germany.
German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany.
Eur Heart J Acute Cardiovasc Care. 2021 Mar 5;10(1):54–61. doi: 10.1177/2048872620930509. Epub 2020 Jun 10.
Conflicting results exist on whether initiation of intraaortic balloon pumping (IABP) before percutaneous coronary intervention (PCI) has an impact on outcome in this setting. Our aim was to assess the outcome of patients undergoing IABP insertion before versus after primary PCI in acute myocardial infarction complicated by cardiogenic shock.
The IABP-SHOCK II-trial randomized 600 patients with acute myocardial infarction and cardiogenic shock to IABP-support versus control. We analysed the outcome of patients randomized to the intervention group regarding timing of IABP implantation before or after PCI.
Of 600 patients included in the IABP-SHOCK II trial, 301 were randomized to IABP-support. We analysed the 275 (91%) patients of this group undergoing primary PCI as revascularization strategy surviving the initial procedure. IABP insertion was performed before PCI in 33 (12%) and after PCI in 242 (88%) patients. There were no differences in baseline arterial lactate ( = 0.70), Simplified Acute Physiology Score-II-score ( = 0.60) and other relevant baseline characteristics. No differences were observed for short- and long-term mortality (pre . post 30-day mortality: 36% . 37%, odds ratio 0.99, 95% confidence interval (CI) 0.47-2.12, = 0.99; one-year mortality: 56% . 48%, hazard ratio 1.08, 95% CI 0.65-1.80, = 0.76; six-year-mortality: 64% . 65%, hazard ratio 1.00, 95% CI 0.63-1.60, = 0.99). In multivariable Cox regression analysis timing of IABP-implantation was no predictor for long-term outcome (hazard ratio 1.08, 95% CI 0.66-1.78, = 0.75).
Timing of IABP-implantation pre or post primary PCI had no impact on outcome in patients with acute myocardial infarction complicated by cardiogenic shock.
对于在经皮冠状动脉介入治疗（PCI）前启动主动脉内球囊反搏（IABP）在此情况下是否会影响预后，存在相互矛盾的结果。我们的目的是评估在急性心肌梗死合并心源性休克患者中，在直接PCI之前与之后进行IABP植入的患者的预后。
IABP-SHOCK II试验将600例急性心肌梗死合并心源性休克患者随机分为IABP支持组和对照组。我们分析了随机分配到干预组的患者在PCI之前或之后进行IABP植入的时间的预后情况。
在IABP-SHOCK II试验纳入的600例患者中，301例被随机分配到IABP支持组。我们分析了该组中作为血运重建策略接受直接PCI且在初始手术中存活的275例（91%）患者。33例（12%）患者在PCI之前进行了IABP植入，242例（88%）患者在PCI之后进行了IABP植入。基线动脉血乳酸（P=0.70）、简化急性生理学评分II（P=0.60）及其他相关基线特征方面无差异。短期和长期死亡率也无差异（PCI前与PCI后30天死亡率：36%对37%，优势比0.99，95%置信区间[CI]0.47-2.12，P=0.99；1年死亡率：56%对48%，风险比1.08，95%CI 0.65-1.80，P=0.76；6年死亡率：64%对65%，风险比1.00，95%CI 0.63-1.60，P=0.99）。在多变量Cox回归分析中，IABP植入时间不是长期预后的预测因素（风险比1.08，95%CI 0.66-1.78，P=0.75）。
在急性心肌梗死合并心源性休克患者中，IABP植入在直接PCI之前或之后的时间对预后无影响。
