my personal edition > angina pectoris/mi > news


  E-Mail this DGDispatch to a colleague

DGDispatch

High Volume of Intra-Aortic Balloon Counterpulsation Procedures Associated with Lower Mortality: Presented at AHA

By Jill Stein

CHICAGO, IL -- November 21, 2002 -- Patients with acute myocardial infarction (MI) with cardiogenic shock who undergo an intra-aortic balloon counterpulsation procedure have a lower mortality risk if they are treated at a high volume rather than a low volume facility, say researchers.

This finding was reported here November 20 at the 2002 Scientific Sessions of the American Heart Association (AHA).

Dr. Edmond W. Chen, with the University of Alabama in Birmingham, Alabama, United States, and colleagues reviewed data on 12,370 patients at 750 hospitals who were enrolled in the National Registry of Myocardial Infarction (NRMI) 2 from 1994-1998. The hospitals were divided into tertiles depending on the number of intra-aortic balloon counterpulsation (IABP) procedures performed per year (low-, intermediate-, and high-volume).

"Acute MI complicated by cardiogenic shock remains a leading cause of death in patients hospitalised with acute MI, and conventional fibrinolytic therapy alone is often unsuccessful, " Dr. Chen said. "Intra-aortic balloon counterpulsation has served an important role in haemodynamic support of these critically ill patients."

The use of IABP in conjunction with thrombolytic therapy decreased the odds of death by 18 percent in the patients in NRMI 2 with cardiogenic shock, he continued. The outcome of selected medical, interventional, and surgical procedures such as percutaneous coronary intervention is increasingly associated with hospital and operator volume. It remains unclear whether the number of IABP procedures performed at a given hospital is associated with mortality in patients with cardiogenic shock.

In the present study, the median number of IABP procedures performed per hospital per year was 3.4, 12.7, and 37.4 at low-, intermediate-, and high-volume hospitals, respectively.

Of those patients who underwent IABP, there were only minor differences in enrollment patient characteristics between the three groups.

In a multivariate analysis, high hospital IABP volume for patients with acute MI was associated with lower mortality (OR = 0.71), independent of baseline patient characteristics, hospital factors, treatment, and procedures such as coronary balloon angioplasty.

Dr. Chen said the results show that IABP remains underutilised in acute MI complicated by cardiogenic shock. Greater efforts should be directed to increasing IABP rate, and training and improvement of care for patients with cardiogenic shock.

He cautioned that the results may be confounded by the fact that information regarding complications associated specifically with IABP, the timing of cardiogenic shock, and timing of IABP were not pre-specified variables in NRMI and were unavailable for analysis.

The study was supported by a grant from Genentech, Inc. in South San Francisco, and Datascope Corp. in Fairfield, New Jersey.

E-Mail this DGDispatch to a colleague

To print, use this version