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Intra-Aortic Balloon Counterpulsation and Acute MI Outcome

Intra-aortic balloon pumping reduces afterload and increases coronary blood flow. Previous studies have suggested that routine use may effectively improve reperfusion following thrombolysis or balloon angioplasty. This single-center Dutch study randomized 238 patients who presented within three hours of MI symptom onset to treatment with or without an intra-aortic balloon pump.

Rates for the combined endpoint of death, nonfatal reinfarction, stroke, or an ejection fraction less than 30 percent at six months were identical (26 percent) for both groups, and enzymatic infarct size and left ventricular ejection fraction did not differ significantly between groups. However, 8 percent of patients who received the intra-aortic balloon pump experienced major complications (e.g., bleeding, limb ischemia, or infection).

Comment: Although these results are weakened by the crossover rates for the intra-aortic balloon pump group and the group that did not receive a balloon pump (25 percent and 31 percent, respectively), they confirm the findings of the multicenter Primary Angioplasty in Myocardial Infarction (PAMI II) trial. Prophylactic intra-aortic balloon pumping after primary angioplasty does not improve clinical outcomes or promote myocardial recovery in high-risk patients with acute MI. As suggested by the authors, intra-aortic balloon counterpulsation should be reserved for hemodynamically unstable patients.

— BJ Meyer

Published in Journal Watch Cardiology August 13, 1999

Citation(s):

Van 't Hof AWJ et al. A randomized comparison of intra-aortic balloon pumping after primary coronary angioplasty in high-risk patients with acute myocardial infarction. Eur Heart J 1999 May 20 659-665.

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