Reduction of risk associated with stent implantation using prophylactic application of aortic balloon counterpulsation in high-risk patients with myocardial infarction

Abstract

Objective To evaluate the effect of prophylactic intra-aortic balloon pump (IABP) on reduction of the incidence of major adverse cardiovascular events (MACE) occurred during perioperative period. Methods A total of 246 high-risk patients with AMI admitted from October 2013 through October 2016 were divided into two groups: prophylactic IABP group(n=144) and remedial IABP group(n=102). The likely complications associated with IABP were observed such as dissecting aneurysm, thrombocytopenia, lower extremity thrombosis, anemia, hematoma at puncture site. The comparison of postoperative heart failure, cardiogenic shock and refractory arrhythmia, and nosocomial death between two groups was carried out. The difference in length of time for treatment with IABP between two groups was compared. Statistical analysis of measurement data expressed in ±s using independent sample t test. Count data expressed in percentage were compared with chi-square test. Non-normal distribution data were checked with median±interquartile range. P<0.05 for the difference was concerned statistically significant. Results Gensini score was higher in prophylactic IABP group (t=2.311, P<0.05). In remedial IABP group, the operative time was longer (t=2.626, P< 0.05), the higher rate of using therapeutic medicine was significant (χ2=60.105, P<0.01), the no reflow rate was higher (χ2=19.920, P<0.01), the amount of contrast agent used was greater (t=2.437, P<0.05), the in-hospital incidence of heart failure was higher (χ2=31.638, P<0.01), the rate of nosocomial postoperative cardiogenic shock was higher (χ2=7.793, P<0.01), and the number of in-hospital death increased (χ2=4.827, P<0.05). Compared with prophylactic IABP group, higher BNP (t=7.447, P<0.05), and lower LVEF (t=3.557, P<0.05) were found in remedial IABP group. Conculsion Prophylactic employment of IABP for the treatment of high-risk AMI patients effectively improved the survival rate and reduced peri-opearative MACE. Key words: Intra-aortic ballon pump; Acute myocardial infarction; Percutaneous coronary intervention; Major adverse cardiovascular events; Heart failure; Cardiac shock