Intra-aortic Balloon Pump Support Research Articles

A case report: successful percutaneous coronary intervention (PCI) in unprotected left main and three-vessel coronary artery disease

Background: Left Main Coronary Artery (LMCA) Disease is the highest-risk lesion of coronary artery disease and is related to cardiovascular morbidity and mortality compared to other types of obstructive Coronary Arterial Disease (CAD). Previously, coronary artery bypass grafting (CABG) was the preferred method for revascularization in significant LMCA lesions; however, results from several trials comparing percutaneous coronary intervention (PCI) with drug-eluting stents (DES) to CABG showed PCI was non-inferior to CABG in highly selected LMCA patients. This report was to describe the contemporary evidence for PCI to CABG in LMCA Disease. Case Presentation: A diabetic and hypertensive 59-year-old man with stable angina pectoris and Canadian Cardiovascular Society (CCS) Score III was referred to Saiful Anwar Hospital for elective PCI consideration. The patient was diagnosed with left main and three-vessel coronary artery disease from CCTA in 2009 and angiography in 2023, then suggested to CABG for revascularization. However, the patient refused CABG surgery and decided to perform PCI with high-risk criteria after an adequate consultation. Considering the high-risk category and reduced ejection fraction, an elective PCI was performed with intra-aortic balloon pump (IABP) support. Then it implanted 2 DES at distal-LM until distal-LCx. In the following procedure, the patient also implanted 1 DES at mid-distal RCA and was discharged with significant improvement in his quality of life. Conclusion: In selected left main and three-vessel coronary artery disease, PCI is successfully improves the patient's quality of life. Keyword: complex PCI, left main coronary artery disease, percutaneous coronary intervention, quality of life

Ambulation in patients with peripheral veno-arterial extracorporeal membrane oxygenation and concomitant femoral intra-aortic balloon pump support.

The mobilization and ambulation of patients with severe cardiogenic shock supported with peripheral veno-arterial extracorporeal membrane oxygenation (pVA-ECMO) and concomitant femoral intra-aortic balloon pump (IABP) support is not well-described. This technical paper describes an ambulation protocol to prevent deconditioning in this critically ill patient population. A protocol for the ambulation of patients with pVA-ECMO and concomitant IABP support was created in December 2022 and implemented at a single center. To initiate ambulation, patients were initially placed in a vertical position utilizing the VitalGo Total Lift Bed (VitalGo Systems, Miramar, FL) with mechanical circulatory support device monitoring performed by a critical care multidisciplinary team. Retrospective analysis of successfully ambulated patients was performed from December 2022 to January 2024. A total of 35 patients out of 112 patients with ECMO support were ambulated in the study period. Four of these patients had pVA-ECMO with concomitant IABP support with this cohort completing a total of 11 sessions during the study period. Patients ambulated an average of 200 feet per session without any adverse events, including cannula and balloon pump migration or displacement. Three of the four patients studied were either bridged to an advanced therapy including orthotopic heart transplant or durable left ventricular assist device or were discharged. A protocol for ambulation of CS patients with pVA-ECMO support and concomitant femoral IABP support is feasible and can safely be implemented in this critically ill patient population. Further multicenter studies are necessary to determine the overall impact of ambulation on patient outcomes.

Haemodynamic effects of intra-aortic balloon pumps stratified by baseline pulmonary artery pulsatility index.

Intra-aortic balloon pump (IABP) devices are commonly used in patients with heart failure related cardiogenic shock (HF-CS), including those with out-of-proportion right ventricular (RV) dysfunction. Pulmonary artery pulsatility index (PAPi) is a haemodynamic surrogate for RV performance. We aimed to assess short-term haemodynamic changes in patients with HF-CS following IABP support stratified by baseline PAPi. This is a single-centre study of 67 consecutive patients with HF-CS who underwent IABP placement between 2020 and 2022. The primary aim was haemodynamic changes of specific variables on pulmonary artery catheter monitoring over 72h following IABP placement. Secondary aims were clinically significant changes in diuretic regimens, changes in inotropes or vasopressors at 72h following IABP, along with clinical outcomes. Prior to IABP placement, 57% of the total cohort (median age 59years [48, 69], 31% female) had Society of Cardiovascular Angiography and Interventions Stage C HF-CS. Thirty-eight (56%) patients had a PAPi <2.0. Following 72h of IABP support, the PAPi <2.0 group had an observed significant decrease in central venous pressure (CVP; 20 to 12mmHg, P<0.001) and mean pulmonary artery pressure (mPAP; 37.5 to 28.5mmHg, P=0.001), and an increase in PAPi (1 to 1.6, P=0.001). No significant change in cardiac index (CI; 2 to 2.1L/min/m2, P=0.31) was observed. The PAPi ≥2.0 group (N=29) had no observed significant change in CVP (10 to 8mmHg, P=0.47), or PAPi (2.6 to 2.8, P=0.92), but there was a significant improvement in CI (1.9 to 2.5L/min/m2, P=0.004) along with reduction in mPA (37 to 29mmHg, P=0.03). The PAPi <2.0 group had a significant increase in diuretic requirement (52.6% vs. 20.7%, P=0.01) and numerically greater addition of inotropes/vasopressors (47.3% vs. 34.4%, P=0.07) compared with the PAPi ≥2.0 group at 72h following IABP placement. Significantly more patients in the PAPi ≥2.0 group underwent left ventricular assist device (55.2% vs. 26.3%, P=0.02), with no overall significant differences observed in escalation to veno-arterial extracorporeal membrane oxygenation, 30-day mortality, renal replacement therapy post-IABP, or rates of heart transplantation. IABP devices in those with HF-CS and low or abnormal PAPi may provide modest short-term haemodynamic benefits without significant improvement in CI, along with greater need for adjustment in medical therapeutics to achieve haemodynamic optimization.

Comparison of ECMO, IABP and ECMO + IABP in the Postoperative Period in Patients with Postcardiotomy Shock.

Background: This study aims to assess the outcomes and complications of patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO) and intra-aortic balloon pump (IABP) support after cardiac surgery at Ankara University Heart Center between 2000 and 2023. Methods: We have carried out a retrospective analysis that included 255 patients. Among them, 98 received IABP, 103 received VA-ECMO, and 54 received both VA-ECMO and IABP. Preoperative and postoperative assessments were carried out, including evaluations of left ventricular function and serum creatinine levels. Primary outcomes included 30-day survival and successful VA-ECMO weaning. Complications such as bleeding, sepsis, liver failure, wound infection, and peripheral ischemia were also assessed. Results: The weaning rate from VA-ECMO was significantly higher in the combined VA-ECMO and IABP group (81.4%) compared with the other groups (p = 0.004). One-year survival was also higher in the combined group (75.9%) (p = 0.002). Complications or renal function did not differ significantly among the groups. The primary indication for mechanical support was coronary artery bypass grafting. Conclusions: In conclusion, the combined use of VA-ECMO and IABP therapy led to improved weaning and survival rates without increasing the risk of complications. These findings suggest that a combined approach may be beneficial for selected patients with severe cardiac dysfunction post surgery.

Successful percutaneous coronary intervention in a congenital single right coronary artery with acute myocardial infarction: A case report and literature review.

Single coronary artery (SCA) is a rare coronary artery malformation. SCA combined with atherosclerotic plaques can cause severe and widespread myocardial ischemia and infarction, leading to hemodynamic instability and even sudden death. A 48-year-old Chinese man was admitted for treatment of persistent chest tightness and panic for 5 hours. The patient was a lorry driver with high work intensity and mental stress, with body mass index of 33.78, history of smoking and alcohol consumption, but no history of hypertension and diabetes. Admission examination showed Troponin was 183.083 µg/L and CK-MB value was >300 µg/L. The patient was diagnosed with a congenital single right coronary artery (RCA) with acute myocardial infarction (AMI) by coronary angiography (CAG). Due to atherosclerotic plaques rupture, a complete occlusion of the proximal RCA with thrombolysis in myocardial infarction grade 0 of distal blood flow were found. The patient was treated with thrombus aspiration and thrombolytic therapy by percutaneous coronary intervention under the support of intra-aortic balloon pump. Postoperative the chest tightness and panic were relieved, and CAG revealed that the proximal thrombus of the RCA was reduced, and distal blood flow was restored to thrombolysis in myocardial infarction grade 3. After 2 weeks of intensive antithrombotic and lipid-regulating drug therapy, the patient was successfully discharged. Follow-up for 6 months, the patient was able to live and work normally without experiencing chest tightness and chest pain. Computed tomography angiography (CTA) confirmed a congenital single RCA with patent lumen and no severe stenosis. The congenital single RCA is very rare, and it is fatal in conjunction with acute coronary syndrome. Early detection and appropriate treatment is critical for AMI patient with single RCA. CAG is the gold standard for diagnosis of single RCA, and CTA is a necessary to describe the anatomical course of abnormal coronary arteries.

Successful Emergency Percutaneous Coronary Intervention of Challenging Unprotected Left Main Coronary Artery Disease Patient: How to Prepare and Optimize

Background: Myocardial infarction (MI) due to unprotected left main coronary artery disease (ULMCAD) is a relatively uncommon presentation. It represents as the anatomical subset of coronary artery disease (CAD) with the highest risk of atherosclerotic obstructive CAD. In the setting of acute MI, the treatment options are limited in this particular condition. Major advances in the field of PCI have made PCI as a viable option for patients with ULMCAD who are equally suited for CABG or PCI. This study aimed to describe the contemporary evidence PCI for ULMCAD. Case Illustration: A man was admitted to our hospital with crescendo angina accompanied with dyspnea. Electrocardiogram (ECG) showed biphasic t wave on V2-V5 leads. He continued to experience symptoms of ischemia and had increased serial cardiac enzymes. Intra-aortic balloon pump (IABP) support was implemented before performing the PCI. After eight days of hospitalization, he was discharged with stable hemodynamics. Conclusion: PCI has risks and advantages when performed on patients with complex CAD, including ULMCAD. The prognosis for this high-risk patient group can be improved with thorough preparation and effective treatment strategies. Keyword: Coronary Artery Disease, Myocardial Infarction, Percutaneous Coronary Intervention.

The Impact of Ipsilateral Implantable Cardioverter Defibrillator in Axillary Intra-Aortic Balloon Pump Support as Bridge to Heart Transplantation.

The axillary artery (AX) access for intra-aortic balloon pump (IABP) as a bridge to heart transplant (HT) allows mobility while awaiting a suitable donor. As end-stage heart failure patients often have an implantable cardioverter defibrillator (ICD) on the left side, the left AX approach may be avoided due to the perception of difficult access and proximity of two devices. We aimed to evaluate the outcomes of patients bridged to HT with a left-sided AX IABP with or without ipsilateral ICDs. We retrospectively reviewed HT candidates at our institution supported by left-sided axillary IABP from November 2019 to February 2024, dividing them into two groups based on the presence (Group ICD, n = 48) or absence (Group No-ICD, N = 19) of an ipsilateral left-sided ICD. The exposure time was defined as the time from skin incision to the beginning of anastomoses of a Dacron graft. Technical success was achieved in 100% of the cohort, with median exposure times for AX access similar between groups (ICD, 12 [7.8, 18.2] vs. No ICD, 11 [7, 19] min; p = 0.75). The rate of procedural adverse events, such as significant access site bleeding and ipsilateral limb ischemia, did not significantly differ between both groups. Device malfunction rates were comparable (ICD, 29.2%vs. No ICD, 15.8%; p = 0.35). Posttransplant, in-hospital mortality, severe primary graft dysfunction, and stroke rates were comparable in both groups. The presence of an ipsilateral left-sided ICD does not adversely impact the procedural efficacy, complication rates, or posttransplant outcomes of left-sided AX IABP insertion in HT candidates.

Usefulness of bicarbonate-based Impella purge solution in a patient with heparin-induced thrombocytopenia: the first case report of long-term management in Japan.

Percutaneous mechanical circulatory support utilizing micro-axial flow pumps, such as the Impella group of devices, has become a life-saving technique in the treatment of refractory cardiogenic shock, with ever-increasing success rates. A 30-year-old man presented with acute decompensated heart failure and a severely reduced left ventricular ejection fraction (17%). Despite initial treatment with inotropic drugs and intra-aortic balloon pump support, his hemodynamic status remained unstable. Transition to Impella CP mechanical circulatory support was made on day 6 owing to persistently low systolic blood pressure. A significant decline in platelet count prompted suspicion of heparin-induced thrombocytopenia (HIT), later confirmed by positive platelet-activated anti-platelet factor 4/heparin antibody and a 4Ts score of 6 points. Argatroban was initially used as the purge solution, but owing to complications, a switch to Impella 5.0 and a bicarbonate-based purge solution (BBPS) was performed. Despite additional veno-arterial extracorporeal membrane oxygenation support on day 24, the patient, aiming for ventricular assist device treatment and heart transplantation, died from infection and multiple organ failure. Remarkably, the Impella CP continued functioning normally until the patient's demise, indicating stable Impella pump performance using BBPS. This case highlights the usefulness of BBPS as an alternative to conventional Impella heparin purge solution when HIT occurs.

Clinical characteristics of delirium in older patients with first-ever acute myocardial infarction who underwent percutaneous coronary intervention : Aretrospective study.

Delirium is aserious complication of cardiac surgery and acommon clinical problem. The study aimed to identify the incidence, risk factors, and outcomes of delirium in older patients (≥ 65years) with first-ever acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI). Aretrospective cohort study was performed in ahospital in northern China. Atotal of 1033 older patients with first-ever AMI who underwent PCI between January 2018 and April 2021 were screened for delirium using the CAM-ICU method. Clinical and laboratory data were collected. Atotal of 134 (12.97%) patients were diagnosed with delirium. Patients with delirium were older. The most common concomitant diseases were cardiac arrest, chronic renal failure, and ahistory of coronary artery bypass graft (CABG). Delirious patients experienced more times of mechanical ventilation, more intra-aortic balloon pump (IABP) support, high postoperative immediate pain score (VAS), more non-bedside cardiac rehabilitation, and longer total length of stay and cardiac care unit (CCU) time. Multivariable logistic regression showed that age, mechanical ventilation, postoperative immediate pain score, and non-bedside cardiac rehabilitation were independently associated with delirium. Delirium was an independent predictor of prolonged CCU stay, total length of stay, and 1‑year mortality. Age, mechanical ventilation, postoperative immediate pain score, and non-bedside cardiac rehabilitation were independently closely related to delirium in older patients with first-ever AMI who underwent PCI. Delirium was associated with ahigher 1‑year all-cause mortality.

Acute-on-chronic heart failure leading to cardiogenic shock: any role for intra-aortic balloon pump? Results from a multicenter retrospective data collection

Abstract Funding Acknowledgements None. Background Intra-aortic balloon pump (IABP) implantation has been significantly reduced since IABP-SHOCK II trial did not show any clinical benefit in acute myocardial infarction (AMI)-related cardiogenic shock (CS)(1). For a long time, AMI has been recognized as the first cause of CS; however, in the last years, acute-on-chronic heart failure (HF)-CS has become predominant. We hypothesized that in HF-CS population the IABP may decrease mortality having a role in decreasing left ventricular afterload and improving peripheral perfusion(2). Purpose To investigate whether, in this phenotypical category of cardiogenic shock, IABP could improve 28-days mortality. Methods Multicenter retrospective observational study including adult HF-CS patients admitted in cardiac or general intensive care units in 3rd level centers. Hemodynamic variables before (T0) and after IABP implantation (T1), pharmacological support and outcome data were collected. Independent samples t-test was applied to assess any difference between IABP and non-IABP group; Kaplan-Meier and Cox’s regression (forward stepwise method) were performed as survival analysis on 28-days mortality. Results 160 patients (35.6% female, 61 [47-74] years-old) were included from three centers; overall mortality was 42.5%. 50% received IABP support; amongst IABP patients, 24 received further MCS with VA-ECMO (p &amp;lt;0.001) and 4 with Impella (p 0.120). Patients’ baseline characteristics are shown in Figure 1-A. IABP patients had lower 28-days mortality. Patients who received IABP were younger, had lower systolic blood pressure (SBP), pulse pressure (PP) and lactate levels at T0. In reference to catecholaminergic drugs, patients supported with IABP had lower norepinephrine doses and vasoactive inotropic score (VIS) at baseline. After IABP implantation, no significant difference between the two groups in the time variation of these parameters was observed (Figure 1-B). Survival analysis graphs are shown in Figure 2. At Cox’s regression, a significant effect on 28-days mortality was found for IABP (HR 0.510 [0.293-0.887], p 0.017), SCAI classification-stage D (HR 2.582 [1.315-5.072], p 0.006), VIS-T0 above 15 (HR 2.348 [1.407-3.921], p 0.001) and SBP-T0 above 95 mmHg (HR 1.361 [1.016-1.823], p 0.039); no significant association was found for age above 61 years (overall median value) (p 0.091), mechanical ventilation (p 0.367), PP-T0 (0 0.081) and lactate-T0 (p 0.227). Conclusions Considering the specific pathophysiology of HF-CS, IABP may have a role in reducing mortality. These retrospective data need to be validated and compared with those deriving from ongoing randomized controlled trials(3).

What if youth is not enough? Acute coronary syndrome in young patients

Abstract Funding Acknowledgements None. Background Acute Coronary Syndromes (ACS) are the leading cause of mortality in Spain. Further research is needed in order to know risk factors and outcomes in young patients so that medicians could optimize their management and prevention. Purpose Identifying risk factors, clinical characteristics and short-term outcomes in Acute Coronary Syndrome in patients aged 40 and under. Methods A retrospective analysis of patients under 40 years of age who were admitted for ACS, out of 3,859 ACS admissions in Cardiology Intensive Care Unit (CICU) in our hospital between 2012 and 2022. Results 67 patients (1.73%) were included, most of them were males (83.6%). Baseline characteristics are summarized in Table 1. 77.6% had hypertension (HTA), 22.4% had diabetes (DM) and 34.3% had dyslipidemia (DLP). 79.1% were smokers, 9.1% had a history of alcoholism and 29.9% were cocaine users. None of them had a history of stroke, atrial fibrillation (AF). Only 3% had ischemic heart disease. 68.7% of them were ST-elevation myocardial infarction (STEMI) and inferior STEMI was the most common (38.7%). In anterior STEMI (22 patients), 15 had a severe lesion in the mid-left anterior descending artery (LAD), and 6 in the left main stem (LM). Single-vessel disease was the most common (70.8%), with 3-vessel disease in 4.6%. 75.8% received percutaneous coronary intervention (PCI), and 3% underwent bypass surgery. During admission, 10.5% progressed to Killip class III-IV. The ICU mortality was 1.5%. 9% received vasoactive drugs and 4.5% were intubated. Non-invasive ventilation was used in 3% and high-flow nasal cannula oxygen therapy in 5.3%. 3% received intra-aortic balloon pump support and 1.5% underwent dialysis or ultrafiltration. 4.5% received an implantable cardioverter-defibrillator (ICD), although none of them developed bundle branch block or atrioventricular node block, nor AF. After discharge, 11.1% had recurrent ACS, and up to 5.6% underwent PCI again, with a mortality rate of 11.8%. Conclusion Approximately 2% of ACS occur in people younger than 40 years of age. Substance abuse (smoking, cocaine and alcoholism) becomes more prevalent in this group. Prevalence of comorbidities (such as diabetes and nephropathy) are lower, making them less prone to short-term heart failure. However, they are more susceptible to recurrent ischemic events. There is a high incidence of inferior STEMI and LM-STEMI. For these reasons, medicians may need to find out a substance abuse in this group and further research into other risk factors, such as coronary disease family history.Basal characteristicsClinical evolution of patients

Correlation between Post-operative Serum Lactate Levels and Low Cardiac Output Syndrome in Patients Undergoing Coronary Artery Bypass Grafting Surgery: A Prospective Study in a Tertiary Care Hospital

Objectives: This study aimed to assess the correlation between the development of low cardiac output syndrome (LCOS) and post-operative serum lactate levels in patients undergoing coronary artery bypass grafting (CABG) surgery at a tertiary care hospital. Methodology: A prospective cross-sectional study was conducted from January to June 2021, involving 50 patients undergoing CABG surgery with cardiopulmonary bypass. Arterial samples were obtained immediately post-surgery and at six, twelve, and twenty-four-hour intervals post-operatively. The association between lactate levels and the occurrence of LCOS, need for inotropic support, and intra-aortic balloon pump (IABP) utilization was evaluated. Results: The study comprised predominantly male patients (84%). Patients were categorized into two groups based on lactate levels: Group 1 (&gt; 4 mmol/L) and Group 2 (&lt; 4 mmol/L). In Group 1, 32% of patients developed LCOS, 10% required IABP, and 20% needed inotropic and vasopressor support. Immediately post-CABG, the mean lactate level was 7.5 mmol/L, with 3% requiring IABP and 20% needing double inotropic support. Lactate levels decreased over time, with mean levels at six, twelve, and twenty-four hours post-surgery being 6.3 mmol/L, 3.8 mmol/L, and 3.3 mmol/L, respectively. Correspondingly, the need for IABP and inotropic support decreased. LCOS occurrence within 24 hours post-surgery correlated significantly with elevated lactate levels (p &lt; 0.05). Conclusion: Elevated lactate levels were associated with the development of LCOS within 24 hours post-CABG surgery. Monitoring lactate levels postoperatively may serve as a valuable tool in predicting and managing LCOS in CABG patients.

RotaTripsy Risk and Rewards: Findings from a Registry of Patients Undergoing Combined Rotational Atherectomy and Intravascular Lithotripsy

Background: Heavily calcified coronary artery lesions are a therapeutic challenge for interventional cardiologists worldwide. Recently, RotaTripsy has gained popularity as a calcium modification technique prior to stent implantation. In this procedure, operators employ rotational atherectomy to debulk luminal calcium alongside intravascular lithotripsy to fracture deeper concentric calcifications. Aims: To identify the demographics and outcomes of patients undergoing RotaTripsy. Methods: Baseline clinical characteristics, procedural details and in-hospital and 30-day outcomes were recorded and reported for a registry of patients in whom combined rotational atherectomy and intravascular lithotripsy were performed in one procedure at the discretion of the primary operator at one high-volume tertiary centre. Results: Over 2020–2022, 57 consecutive patients underwent RotaTripsy during percutaneous coronary intervention. In this cohort, 23 (40%) had acute coronary syndrome and three (5.3%) had an ST-elevation MI. Additionally, 10 (18%) were on dialysis, 20 (35%) had unprotected left main coronary artery/left main coronary artery equivalent lesions, seven (12%) had acute heart failure and nine (16%) required intraprocedural intra-aortic balloon pump support. Of the procedures, 51 (89.5%) were successful, defined as successful stent implantation and &lt;30% residual angiographic stenosis without in-hospital major adverse cardiac events. Complications included slow/no-reflow (six patients; 11%), cerebrovascular events (three patients; 5.3%), in-hospital MI (three patients; 5.3%) and mortality (three patients; 5.3%). The 30-day MI rate was 5.3% (three patients) and the mortality rate was 7.0% (four patients). Conclusion: RotaTripsy was successful in facilitating stent delivery and restoring flow, even in a relatively sick cohort. Nevertheless, complication rates were high, reflecting the challenge of treating these complex patients.

Predictors of left ventricular ejection fraction in high-risk percutaneous coronary interventions.

Revascularization completeness after percutaneous coronary intervention (PCI) is associated with improved long-term outcomes. Mechanical circulatory support [intra-aortic balloon pump (IABP) or Impella] is used during high-risk PCI (HR-PCI) to enhance peri-procedural safety and achieve more complete revascularization. The relationship between revascularization completeness [post-PCI residual SYNTAX Score (rSS)] and left ventricular ejection fraction (LVEF) in HR-PCI has not been established. We investigated LVEF predictors at 90 days post-PCI with Impella or IABP support. Individual patient data (IPD) were analyzed from PROTECT II (NCT00562016) in the base case. IPD from PROTECT II and RESTORE-EF (NCT04648306) were naïvely pooled in the sensitivity analysis. Using complete cases only, linear regression was used to explore the predictors of LVEF at 90 days post-PCI. Models were refined using stepwise selection based on Akaike Information Criterion and included: treatment group (Impella, IABP), baseline characteristics [age, gender, race, New York Heart Association Functional Classification, LVEF, SYNTAX Score (SS)], and rSS. Impella treatment and higher baseline LVEF were significant predictors of LVEF improvement at 90 days post-PCI (p ≤ 0.05), and a lower rSS contributed to the model (p = 0.082). In the sensitivity analysis, Impella treatment, higher baseline LVEF, and lower rSS were significant predictors of LVEF improvement at 90 days (p ≤ 0.05), and SS pre-PCI contributed to the model (p = 0.070). Higher baseline LVEF, higher SS pre-PCI, lower rSS (i.e. completeness of revascularization), and Impella treatment were predictors of post-PCI LVEF improvement. The findings suggest potential mechanisms of Impella include improving the extent and quality of revascularization, and intraprocedural ventricular unloading.

Intra-Aortic Balloon Pump Support in Patients with Acute Myocardial Infarction with Ventricular Septal Rupture

Background: An intra-aortic balloon pump (IABP) is the device most frequently used as a bridge to surgical repair in cases of myocardial infarction. However, robust evidence of IABP support for patients with postinfarction ventricular septal rupture (VSR) remains lacking. This study was aimed at assessing the effect of IABP support on 30-day prognosis in patients with acute myocardial infarction (AMI) complicated by VSR. Methods: Retrospective data for patients with VSR after AMI at Fuwai Hospital between April 2002 and August 2020 were analyzed. Patients were initially stratified into two groups according to IABP implantation. The Kaplan-Meier method was used to determine the cumulative incidence of 30-day all-cause mortality. Multivariate logistic regression was used to evaluate the independent risk factors for 30-day mortality. Results: A total of 92 patients (mean age of 67.8 ± 8.3 years; 46.7% male) were included, 59 of whom underwent IABP implantation. Patients with rather than without IABP treatment were younger, were more often male, and had a higher body mass index and lower mean blood pressure at the onset of VSR. At 30 days, all-cause death occurred in 21 patients in the IABP group (35.59%) and 31 patients in the group without IABP (93.94%). After adjustment for age, sex, left atrial diameter, left ventricular diameter, perforation diameter and ventricular aneurysm, IABP support was found to be an independent protective predictor of 30-day all-cause mortality (hazard ratio: 0.22; 95% confidence interval: 0.12 to 0.42; P &lt; 0.001). Conclusions: IABP support was associated with lower 30-day mortality in patients with VSR after AMI. Patients with postinfarction VSR with hemodynamic instability or cardiogenic shock could receive IABP treatment as a bridge to surgical repair.

Bloodstream infections in prolonged use of axillary-placed, intra-aortic balloon-pump support: A single-center study.

Infections from prolonged use of axillary intra-aortic balloon pumps (IABPs) have not been well studied. Bloodstream infection (BSI) occurred in 13% of our patients; however, no difference in outcome was noted between those with BSI and those without. Further studies regarding protocol developments that minimize BSI risk are needed.

Predictive value of residual SYNTAX score for clinical outcomes after High-Risk Percutaneous Coronary Intervention (HR-PCI): Evidence from pooled analysis of prospective studies

Abstract Background/Introduction Completeness of revascularisation (CR) after percutaneous coronary intervention (PCI), which is associated with improved long-term patient outcomes, is commonly quantified with the post-PCI residual SYNTAX score (rSS). In High-Risk PCI (HR-PCI), trans-axial percutaneous Left Ventricular Assist Devices (pLVADs) provide higher procedural mechanical circulatory support than intra-aortic balloon pump (IABPs). We hypothesise that pLVADs may contribute to higher CR during HR-PCI. A direct quantitative relationship between revascularisation extent, measured via rSS, and long-term clinical outcomes has not yet been established in HR-PCI. NYHA Class allocation 90-days post-PCI and Ejection Fraction (EF) have been shown strongly predictive of long-term survival, Heart Failure (HF) hospitalization risk and Quality of Life (QoL). Purpose To investigate the relationship between revascularization completeness, NYHA Class and LVEF 90-days in patients undergoing HR-PCI with either pLVAD or IABP support. Methods Individual patient data (IPD) from the PROTECT II and RESTORE-EF prospective studies of pLVADs during HR-PCI were pooled. Using patients with sufficient information, ordinal logistic regressions were performed for NYHA and EF at 90-days post-PCI. All models were refined using stepwise deletion (threshold=0.05) and included treatment group (pLVAD or IABP), baseline age, gender, race, NYHA Class at baseline, LVEF at baseline, SYNTAX Score at baseline and post-procedural rSS. Results NYHA Class utilised 641 patients (484 pLVAD;157 IABP). Baseline SYNTAX, rSS and LVEF at baseline were significant predictors of NYHA Class at 90-days post HR-PCI. Specifically, a single-unit decrease in rSS increases the odds of the patient improving NYHA at 90-days vs. baseline by 2.2%±1.0% (Mean±SE, p=0.021). Utilising solely the subjects with sufficient information enrolled in PROTECT II (178 pLVAD; 157 IABP), post-procedural rSS was the only significant predictor of NYHA Class at 90-days with every single-unit decrease in rSS increasing the odds of NYHA improvement by 3.0%±1.2% (p=0.017). EF examined 622 (405 pLVAD; 217 IABP). Baseline SYNTAX, rSS and baseline LVEF significantly predicted Ejection Fraction at 90-days. A single-unit decrease in rSS leads to an absolute higher LVEF at 90-days of 0.246%±0.05% (p&amp;lt;0.001). Treatment group statistically predicted LVEF at 90-days. For the same level of revascularisation, pLVAD-supported procedures result in an absolute higher LVEF of 4.13%±1.21% (p=0.001). Conclusions Completeness of revascularization, as measured by level of reduction in rSS after a HR-PCI, is significantly predictive of NYHA Class improvement and Ejection Fraction gains at 90-day follow-up. pLVADs were also shown to further increase LVEF at 90-days vs. IABP. These data further support the need for complete revascularization in this patient population and help make additional therapeutic decisions post-PCI.

Abstract 11954: Predictors of Adverse Outcome in STEMI Patients Post-PCI With Cardiogenic Shock Requiring Intra-Aortic Balloon Pump Support

Introduction: Cardiogenic shock is a serious complication of ST-segment elevation myocardial infarction (STEMI), however clinical and demographic factors may further impact outcomes. This study investigated how age, gender, income, comorbidities, and arrhythmias affect mortality of STEMI patients receiving intra-aortic balloon pumps (IABP) for management of cardiogenic shock. Methods: This retrospective study used the National Inpatient Sample (NIS) database from 2016 to 2020. We identified STEMI admissions as the principal diagnosis and cardiogenic shock as the secondary diagnosis. Patients who received IABP support were included using the ICD-10 Procedure Coding System (PCS) code 5A02210. Logistic linear regression was used to analyze the data while adjusting for confounding variables such as age, sex, and comorbidities. Results: Of the 24,915 admissions with STEMI requiring IABP post PCI, the average age was 65, 29.5% were female, 28.8% died and 51.7% patients had congestive heart failure. The highest mortality rate was associated with liver disease, followed by left bundle branch block, age over 65, ventricular fibrillation, renal failure, female gender, peripheral vascular disease (PVD), and ventricular tachycardia (table 1). Income in the bottom 25 th percentile also had increased mortality. Conclusion: This study identified several predictors of adverse outcomes in post-PCI STEMI patients with cardiogenic shock requiring IABP support, including ventricular fibrillation, ventricular tachycardia, left bundle branch block, peripheral vascular disease, renal failure, liver disease, age 65 or older, female, and low income. These findings may aid in the management of STEMI patients with cardiogenic shock by allowing healthcare providers to identify patients at high risk for adverse outcomes and tailor their treatment accordingly.

Effect of peri-operative intra-aortic balloon pump in patients undergoing coronary artery bypass grafting on outcomes in a resource limited setting.

Intra-aortic balloon pump (IABP) insertion for diminished myocardial function is standard of care in cardiac surgery. Previous studies have suggested a possible benefit to IABP support before surgery with regards to outcomes and complications. However, there are conflicts with other studies suggesting no significant benefit. Optimal time of insertion, whether preoperative or perioperative (intra-operative and post-operative), has yet to be defined. A retrospective, hospital records-based chart review was conducted for patients admitted to our center from January 2015 to December 2019 for coronary bypass surgery necessitating IABP insertion. Cases were stratified according to the timing of insertion and analyzed according to surgical outcomes and complication rates. Out of 97 patients, 84.5% underwent preoperative IABP insertion while 15.5% of patients received perioperative (Intra-operative or post-operative) insertion. In-hospital mortality was significantly higher in patients with perioperative IABP insertion as compared to the preoperative group (60% vs 20.7%, p = 0.003). However, there were no significant differences between 30-day readmission rates in the two groups (9.8% vs 6.7%, p = 1.000). Length of stay was also higher in patients with preoperative insertion of IABP (p = 0.032), with no significant difference in ICU stay (p = 0.107). Perioperative IABP patients had higher rates of arrhythmias (46.7%, p = 0.042) and reopening of patient (33.3%, p = 0.028). Our study shows improved mortality in patients with preoperatively inserted IABP. This may be beneficial for high-risk patients undergoing CABG surgery. Expanding the use of IABP before CABG in third world countries such as Pakistan may improve overall survival for patients.

Predicting Hemodynamic Changes During Intra-Aortic Balloon Pump Support With a Longitudinal Evaluation.

The use of intra-aortic balloon pump (IABP) has decreased in recent years due to negative outcome studies in cardiogenic shock complicating acute myocardial infarction, despite its favorable adverse-event profile. Acute hemodynamic response studies have identified potential super-responders with immediate improvements in cardiac index (CI) in heart failure patients. This single-center retrospective study aimed to predict CI and mean arterial pressure (MAP) changes throughout the entire duration of IABP support. The study analyzed 336 patients who received IABP between 2016 and 2022. Linear mixed-effect regression models were used to predict CI and MAP improvement during IABP support. The results showed that CI and MAP increases during the first days of support, and changes during IABP support varied with time and were associated with baseline parameters. Longitudinal CI change was associated with body surface area, baseline CI, baseline pulmonary artery pulsatility index, baseline need for pressors, and diabetes. Longitudinal MAP change was associated with baseline MAP, baseline heart rate, need for pressors, or inotropes. The study recommends considering these parameters when deciding if IABP is the most appropriate form of support for a specific patient. Further prospective studies are needed to validate the findings.