Short and long term effect of adjunctive intra-aortic balloon pump use for patients undergoing high risk reperfusion therapy: a meta-analysis of 10 international randomised trials.

OBJECTIVE: Current literature shows there is widespread controversy regarding the indications and outcomes of using an intra-aortic balloon pump (IABP); furthermore, little is known about the late effects of IABP use. DESIGN: To determine whether IABP use can have beneficial effects for patients undergoing high risk reperfusion therapies, by conducting a meta-analysis of randomised trials. SETTING: Databases of Pubmed, Cochrane Library, and Clinicaltrials.gov were searched up to 15 June 2013. PATIENTS: Patients undergoing high risk reperfusion therapies. INTERVENTIONS: Randomised clinical trials comparing IABP with no IABP were considered eligible for this meta-analysis. MAIN OUTCOME MEASURES: Primary outcomes were early (30-day) and long term (≥ 6-month) mortality. RESULTS: Among the 1079 articles retrieved, 10 randomised studies with 2037 high risk patients were included in the quantitative analysis. Meta-analysis revealed that early mortality rate did not differ between the IABP group and the non-IABP group (OR 0.79, 95% CI 0.48 to 1.29). However, long term mortality was significantly reduced in the IABP group (OR 0.63, 95% CI 0.45 to 0.9), and this effect seemed more pronounced in the subset of patients treated with contemporary percutaneous coronary intervention (OR 0.55, 95% CI 0.38 to 0.80). Further analysis found that IABP use was associated with a reduced risk of 30-day re-ischaemia rate (OR 0.62, 95% CI 0.42 to 0.91) and the composite outcome of re-ischaemia and heart failure events (OR 0.75, 95% CI 0.58 to 0.98). No significant heterogeneity was observed. CONCLUSIONS: This meta-analysis suggests that adjunctive IABP use in high risk reperfusion therapy can improve long term survival.

Duke Scholars

Author Mitchell Wolfe Krucoff Medicine, Cardiology