RESUMO
Objective To evaluate the effect of prophylactic intra-aortic balloon pump (IABP) on reduction of the incidence of major adverse cardiovascular events (MACE) occurred during perioperativeperiod.Methods A total of 246 high-risk patients with AMI admitted from October 2013 through October 2016 were divided into two groups:prophylactic IABP group (n =144) and remedial IABP group (n =102).The likely complications associated with IABP were observed such as dissecting aneurysm,thrombocytopenia,lower extremity thrombosis,anemia,hematoma at puncture site.The comparison of postoperative heart failure,cardiogenic shock and refractory arrhythmia,and nosocomial death between two groups was carried out.The difference in length of time for treatment with IABP between two groups was compared.Statistical analysis of measurement data expressed in (x) ± s using independent sample t test.Countdata expressed in percentage were compared with chi-square test.Non-normal distribution data were checked with median ± interquartile range.P ＜ 0.05 for the difference was concerned statistically significant.Results Gensini score was higher in prophylactic IABP group (t =2.311,P ＜ 0.05).In remedial IABP group,the operative time was longer (t =2.626,P ＜ 0.05),the higher rate of using therapeutic medicine was significant (x2 =60.105,P ＜0.01),the no reflow rate was higher (x2 =19.920,P ＜0.01),the amount of contrast agent used was greater (t =2.437,P ＜ 0.05),the in-hospital incidence of heart failure was higher (x2 =31.638,P ＜ 0.01),the rate of nosocomial postoperative cardiogenic shock was higher (x2 =7.793,P ＜0.01),and the number of in-hospital death increased (x2 =4.827,P ＜ 0.05).Compared with prophylactic IABP group,higher BNP (t =7.44 7,P ＜ 0.05),and lower LVEF (t =3.557,P ＜ 0.05)were found in remedial IABP group.Conculsion Prophylactic employment of IABP for the treatment of high-risk AMI patients effectively improved the survival rate and reduced peri-opearative MACE.
RESUMO
Objective To evaluate the feasibility and therapeutic efficacy of prophylactic implantation of intraaortic balloon pump in patients with high-risk coronary artery disease.Methods 121 patients with high-risk coronary heart disease who received prophylactic implantation of intraaortic balloon pump in percutaneous coronary intervention were enrolled as the treatment group (Group A),and another 119 patients with high-risk coronary heart disease who had conventional coronary intervention were enrolled as the control group (Group B).The rates of intraoperative malignant arrhythmia (ventricular tachycardia,ventricular fibrillation),acute left heart failure,cardiogenic shock and sudden death were compared between the two group.NT-proBNP levels,left ventricular systolic function and the rates of major adverse cardiac events,within 30 days of PCI and after 1 year were compared between the two groups.Results The event rates of intraoperative malignant arrhythmia,acute left heart failure,cardiogenic shock,and sudden death in Group A was significantly lower than those in Group B (all P ＜ 0.05).Postoperative hematoma were found in 2 cases,aortic dissection in 1 case and thrombocytopenia in 1 case in Group A without significant difference as compared to Group B (P ＞ 0.05).Within 30 days after PCI,NT-proBNP levels and left ventricular diastolic diameter in Group A were lower than those in Group B while the left ventricular ejection fraction in Group A was higher than that in Group B (all P ＜ 0.05).The rates of major cardiac adverse events,including sudden cardiac death and severe heart failure were lower than those in Group B (all P ＜ 0.05).At 1 year after PCI,the NT-proBNP levels left ventricular diastolic diameter in Group A were lower than those in Group B with the left ventricular ejection fraction in Group A was higher than that in Group B (all P ＜ 0.05).There were no significant differences in the rates of major cardiac adverse events,including sudden cardiac death and severe heart failure after 1 year(all P ＞ 0.05).Conclusions For patients with high-risk coronary heart disease undergoing coronary intervention,prophylactic implantation of intraaortic balloon pump may decrease the incidence of intraoperative complications,reduce the incidence of cardiac death and severe heart failure within 30 days,and improve the left ventricular function after 1 year.Its role in reducing long term major cardiac adverse events after 1 year still needs more clinical trials for funther justification.