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A very long story: intra-aortic balloon pump (IABP) counterpulsation in patients with acute coronary syndrome – a 18-years single-center experience
Session:
Posters (Sessão 1 - Écran 6) - Cuidados Intensivos em Síndromes Coronárias Agudas
Speaker:
Rui Carlos Gregório Antunes Coelho
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Rui Antunes Coelho; Daniel Caeiro; Marisa Passos Silva; Fábio Nunes; Rafael Teixeira; Marta Ponte; Adelaide Dias; Pedro Braga; Ricardo Fontes de Carvalho
Abstract
<p><span style="font-size:14px"><u><strong>Background:</strong></u> Intra-aortic ballon pump (IABP) counterpulsation provides mechanical support for patients with cardiogenic shock. Despite that, the IABP-SHOCK II trial concluded that the use of IABP did not significantly reduce 30-day mortality in patients with cardiogenic shock complicating acute myocardial infarction. 2017 ESC Guidelines downgraded the use of IABP from a class IIb to a class III in patients with STEMI and cardiogenic shock. IABP should be considered for haemodynamic support in patients with mechanical complications (i.e. severe mitral insufficiency or ventricular septal defect) – class IIa recomendation.</span></p> <p><span style="font-size:14px"><u><strong>Purpose:</strong></u> The aim of this study is evaluate the clinical characteristics and outcomes of patients with coronary acute syndrome receiving IABP in a tertiary hospital before and after the ESC Guidelines downgration of recommendation class.</span></p> <p><span style="font-size:14px"><u><strong>Methods:</strong></u> We performed a retrospective observational cohort study of all patients that received IABP in two different intensive care units (general and cardiac), from January 2005 up to August 2022.</span></p> <p><span style="font-size:14px"><u><strong>Results:</strong></u> In a 18-years period, 691 patients underwent IABP. After 2019, we observed a 36% reduction in annual median of IABP implantations (47 cases/year until 2018 vs 17 as of 2019; p = 0,008). Regarding the group who received IABP until 2018, the group evaluated from 2019 onwards had a significantly higher percentage of patients with mechanical complications related to acute coronary syndrome (30.5% vs 9.8%, p <0.001) and severe impairment of ejection fraction - LVEF <30% (55.9% vs 33.4%, p 0.001). This subgroup had more patients undergoing PCI during hospitalization (71.2% vs 39.3%, p = 0.01) and fewer patients undergoing CABG (22.0% vs 39.3%, p < 0.001). There were no statistically significant differences between these two periods regarding the remaining clinical characteristics, cardiogenic shock criteria (present in 45% of patients); Killip-Kimball class; use of inotropes (49.7%); number of days with IABP (median = 2 days); days of hospitalization (median = 8 days); percentage of significant complications related to IABP (5.1%) and in-hospital mortality (24.1%).</span></p> <p><span style="font-size:14px"><u><strong>Conclusions:</strong></u> After the change in ESC Guidelines (2018), the number of patients that received IABP in our center decreased considerably (annual median of 47 vs 17, p = 0.008). From 2019 onwards, there was a significant change in the second main indication for IABP (after cardiogenic shock), which became high-risk PCI (28.8% vs 17.6% of cases; p = 0.029) and not refractory angor or support up to CABG (25.4% vs 42.4%; p = 0.008). Despite the significant reduction in the number of procedures, more mechanical complications related to acute coronary syndrome (30,5% as of 2019 vs 9,8% until 2018; p <0,001) and severe impairment of ejection fraction (55,9% of patients vs 33,4%; p = 0,001), the complications rate related to IABP and in-hospital mortality did not increase significantly.</span></p>
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