Document Detail


The preoperative intraaortic balloon pump in coronary bypass surgery: a lack of evidence of effectiveness.
MedLine Citation:
PMID:  16338247     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: There is limited evidence demonstrating the effectiveness of preoperative intraaortic balloon pump (IABP) use in isolated coronary artery bypass graft (CABG) surgery. A single-center randomized trial demonstrated its benefit. We undertook a multicenter observational study to verify this finding. METHODS: In 29,950 consecutive patients undergoing isolated CABG between 1995 and 2000 at 10 centers, we compared patients with and without a preoperative IABP. We also compared the effect of preoperative IABP use within 7 high-risk clinical subgroups. To validate the previous randomized trial, patients with any 2 of the following were also analyzed: left main > 70%, ejection fraction < 40%, redo CABG, or preoperative intravenous nitroglycerin. RESULTS: Preoperative IABPs were used in 1896 patients (6.3%). These patients had more comorbid conditions and a higher crude mortality than those who did not have preoperative IABPs (9.5% vs 2.3%, P < .0001). Preoperative IABP patients were caliper matched to non-preoperative IABP patients using a propensity score. Excess mortality associated with preoperative IABP persisted (9.2% vs 5.8%, P = .0004). In 7 high-risk subgroups, mortality was significantly higher with preoperative IABP. We used propensity caliper matching to compare preoperative IABP with non-preoperative IABP patients who met trial criteria (n = 4332). Preoperative IABP was associated with higher mortality (11.0% vs 6.5%, P = .0009). Removing emergency patients did not alter results. CONCLUSIONS: Use of preoperative IABPs was consistently associated with higher mortality. Despite detailed statistical analysis, we were unable to show benefit from preoperative IABP use or confirm the results of a single-center trial that demonstrated its benefit. Assessment of preoperative IABP efficacy will require a randomized trial.
Authors:
Roger J F Baskett; Gerald T O'Connor; Gregory M Hirsch; William A Ghali; Kathryn A Sabadosa; Jeremy R Morton; Cathy S Ross; Felix Hernandez; William C Nugent; Stephen J Lahey; Donato Sisto; Lawrence J Dacey; John D Klemperer; Robert E Helm; Andrew Maitland
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  American heart journal     Volume:  150     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-12     Completed Date:  2006-02-14     Revised Date:  2006-02-27    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1122-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Maritime Heart Center, Halifax, Nova Scotia, Canada. rogerbaskett@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Cohort Studies
Coronary Artery Bypass* / mortality
Female
Humans
Intra-Aortic Balloon Pumping*
Male
Preoperative Care*
Prospective Studies
Risk Assessment
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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