Faculty Collaboration Database

Pre-operative intra-aortic balloon counterpulsation in stable patients with left main coronary disease. J Invasive Cardiol 2001 Oct;13(10):679-83

Date

12/04/2001

Pubmed ID

11731684

Scopus ID

2-s2.0-0035488054 (requires institutional sign-in at Scopus site)   24 Citations

Abstract

OBJECTIVE: To determine whether prophylactic, pre-operative, intra-aortic balloon counterpulsation (IABC) improves clinical outcome in stable patients with severe left main coronary artery disease.

METHODS: A post-hoc analysis of 457 prospectively tracked, non-randomized patients undergoing coronary artery bypass graft surgery (CABG) for left main stenoses 50% and multivessel coronary disease, but without any hemodynamic compromise or ongoing angina, was conducted. Patients with heart failure, shock, ongoing ischemia or previous CABG were excluded. In 287 patients, pre-operative IABC was not used (Group 1), while IABC was initiated in 170 patients for "prophylaxis" (Group 2).

RESULTS: Groups 1 and 2 were similar in age (67 +/- 10 years versus 67 +/- 11 years, respectively), sex (72% male versus 71% male, respectively), and body mass index (28 +/- 5.5 versus 27 +/- 5.1, respectively). However, more Group 1 patients had peripheral vascular disease (PVD) (25% versus 11%), but more Group 2 patients had diabetes (37% versus 29%), and a lower left ventricular ejection fraction. The unadjusted 30-day mortality was significantly higher in Group 1 [16 (5.6%) versus 2 (1.2%); p = 0.02]. Cardiopulmonary bypass time and post-operative length of stay did not differ between the two groups. After adjusting for PVD in the multivariate analysis, the p-value for the no IABP versus IABP comparison in the presence of PVD was 0.10, even though 0/18 patients with PVD and IABC died.

CONCLUSION: While unadjusted mortality appears lower with prophylactic IABC, confounding variables such as PVD mandate a larger, randomized clinical trial in order to establish the role of IABC in stable patients with left main disease.

Author List

Fasseas P, Cohen M, Kopistansky C, Bowers B, McCormick DJ, Kasper K, Christenson JT, Parris TM, Miller MF

Author

Panayotis Fasseas MD Associate Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Age Factors
Aged
Blood Flow Velocity
Cohort Studies
Coronary Artery Bypass
Coronary Artery Disease
Coronary Stenosis
Echocardiography, Transesophageal
Female
Humans
Intra-Aortic Balloon Pumping
Length of Stay
Male
Middle Aged
Multivariate Analysis
Peripheral Vascular Diseases
Philadelphia
Predictive Value of Tests
Preoperative Care
Registries
Stroke Volume
Survival Analysis
Treatment Outcome