ESC: Addition of IABC to PCI Doesn't Reduce Infarct Size

Intra-aortic balloon counterpulsation plus primary PCI does not reduce infarct size more than PCI

TUESDAY, Aug. 30 (HealthDay News) -- For patients with anterior ST-segment elevation myocardial infarction (STEMI) without shock, use of intra-aortic balloon counterpulsation (IABC) plus percutaneous coronary intervention (PCI) does not reduce the size of myocardial infarct more than PCI alone, according to a study published online Aug. 29 in the Journal of the American Medical Association, to coincide with its presentation at the European Society of Cardiology Congress 2011, held Aug. 27-31, in Paris, France.

Manesh R. Patel, M.D., from the Duke University Medical Center in Durham, N.C., and colleagues investigated whether placement of routine IABC prior to reperfusion in 337 patients with anterior STEMI without shock reduces myocardial infarct size. IABC was initiated before primary PCI and continued for at least 12 hours (IABC plus PCI), and compared with primary PCI alone from 2009 to 2011. Cardiac magnetic resonance imaging was performed three to five days after PCI to assess infarct size as the primary end point. All-cause death at six months, and vascular complications and major bleeding at 30 days were the secondary outcome measures.

The investigators found that the median time between first contact and first coronary device was 77 and 68 minutes for the IABC-plus-PCI group and the PCI-alone group, respectively. The mean infarct size was not significantly different between the patients in the IABC-plus-PCI and the PCI-alone groups, and in patients with proximal left anterior descending Thrombolysis in Myocardial Infarction flow scores of 0 or 1. At 30 days, there were no significant differences between the groups in major vascular complications, major bleeding, or transfusions. By six months, three and nine patients in the IABC-plus-PCI group and the PCI-alone group had died, respectively.

"Among patients with acute anterior STEMI without shock, IABC plus primary PCI compared with PCI alone did not result in reduced infarct size," the authors write.

Several of the study authors disclosed financial ties with the pharmaceutical and medical technology industry, including Macquet (formerly Datascope), which funded the study.

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