{"id":11346,"date":"2011-08-30T17:26:55","date_gmt":"2011-08-30T21:26:55","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=interventional&p=11346"},"modified":"2011-09-01T12:54:32","modified_gmt":"2011-09-01T16:54:32","slug":"intra-aortic-ballon-counterpulsation-iabp-burned-to-a-crisp","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/08\/30\/intra-aortic-ballon-counterpulsation-iabp-burned-to-a-crisp\/","title":{"rendered":"Intra-Aortic Balloon Counterpulsation (IABP) Burned to a CRISP"},"content":{"rendered":"

Intra-aortic balloon counterpulsation (IABP) is a bust in AMI patients without cardiogenic shock,<\/em><\/strong> according to the Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP AMI) trial<\/a>.<\/p>\n

This open-label, 30-center, randomized, controlled trial was performed to determine if a routine strategy of IABP before primary PCI (and continued for at least 12 hours afterward) would reduce infarct size in patients with acute anterior STEMI without cardiogenic shock.\u00a0A 6-month follow-up for clinical events was also conducted.<\/p>\n

The routine use of IABP in patients with anterior STEMI without cardiogenic shock did not lead to a reduction in infarct size or to an improvement in clinical outcomes at 6 months.<\/p>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n\n\n
\n

Endpoints<\/strong><\/p>\n<\/td>\n

\n

IABP + PCI<\/strong><\/p>\n

(n=161)<\/strong><\/p>\n<\/td>\n

\n

PCI<\/strong><\/p>\n

(n=176)<\/strong><\/p>\n<\/td>\n

\n

P value<\/strong><\/p>\n<\/td>\n<\/tr>\n

4 days<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u00a0\u00a0\u00a0\u00a0 \u2013 Infarct size<\/td>\n\n

42%<\/p>\n<\/td>\n

\n

37.5%<\/p>\n<\/td>\n

\n

0.06<\/p>\n<\/td>\n<\/tr>\n

30 days<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u00a0\u00a0\u00a0 \u2013 Major bleeding or transfusion<\/td>\n\n

3.1%<\/p>\n<\/td>\n

\n

1.7%<\/p>\n<\/td>\n

\n

0.49<\/p>\n<\/td>\n<\/tr>\n

\u00a0\u00a0\u00a0 \u2013 Major vascular complications<\/td>\n\n

4.3%<\/p>\n<\/td>\n

\n

1.1%<\/p>\n<\/td>\n

\n

0.09<\/p>\n<\/td>\n<\/tr>\n

6 months<\/td>\n<\/td>\n<\/td>\n<\/td>\n<\/tr>\n
\u00a0\u00a0 \u2013 Death<\/td>\n\n

1.9%<\/p>\n<\/td>\n

\n

5.2%<\/p>\n<\/td>\n

\n

0.12<\/p>\n<\/td>\n<\/tr>\n

\u00a0\u00a0 \u2013 Composite (death, recurrent MI,
\nheart failure)<\/td>\n		\n

6.3%<\/p>\n<\/td>\n

\n

10.9%<\/p>\n<\/td>\n

\n

0.15<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

 <\/p>\n

As the accompanying editorial <\/a>points out,\u00a0five randomized trials have previously assessed the role of IABP in patients with AMI without cardiogenic shock; in aggregate, they also show no mortality benefit (21 deaths\u00a0in 518 patients in the IABP groups vs. 21 deaths\u00a0in 536 patients in the control groups).<\/p>\n

Based on this (and previous) studies, what is the role of IABP in AMI?<\/em><\/strong>\u00a0 In the absence of cardiogenic shock, there\u2019s no benefit.<\/p>\n

What about IABP for AMI and cardiogenic shock?<\/em><\/strong>\u00a0 Even though it’s \u201cguideline-recommended,\u201d it\u2019s not been properly studied.\u00a0 A randomized trial <\/a>is underway, with\u00a0plans to enroll 600 patients with STEMI and shock<\/p>\n

Would you enroll your patients with cardiogenic shock in this trial, knowing there\u2019s a chance they won\u2019t get IABP?\u00a0 <\/em><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"

Intra-aortic balloon counterpulsation (IABP) is a bust in AMI patients without cardiogenic shock, according to the Counterpulsation to Reduce Infarct Size Pre-PCI Acute Myocardial Infarction (CRISP AMI) trial. This open-label, 30-center, randomized, controlled trial was performed to determine if a routine strategy of IABP before primary PCI (and continued for at least 12 hours afterward) […]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9],"tags":[239,965,326,323,245,257],"class_list":["post-11346","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology","tag-acs","tag-crisp-ami","tag-esc","tag-iabp","tag-mi","tag-stemi"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/11346","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=11346"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/11346\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=11346"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=11346"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=11346"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}