[Intra-aortic balloon pump (IABP) counterpulsation. Do we still need it and if so when?]. / Intraaortale Gegenpulsation (IABP). Brauchen wir sie noch und wenn ja wann?

Intra-aortic balloon pump (IABP) counterpulsation was for a long time considered to be an indispensable standard for support of drug therapy for all forms of acute left-sided cardiac failure and especially in cardiogenic shock due to infarction. The advantages of the system seemed to be obvious; however, many of the postulated effects on the hemodynamics, microcirculation and coronary perfusion could not be confirmed later in prospective studies. It was found that IABP had no influence on microcirculation disorders in cardiogenic shock due to infarction. In a meta-analysis on the application for acute myocardial infarction without shock, no effect was found on mortality. The benefit as adjunct therapy for percutaneous coronary interventions (PCI) in cardiogenic shock due to infarction places a question mark over both IABP-SHOCK studies; however, in constellations without PCI the additional benefit of IABP cannot be excluded which is why the procedure could be an option in this situation.

Cardiac Arrest: A Treatment Algorithm for Emergent Invasive Cardiac Procedures in the Resuscitated Comatose Patient.

Patients who are comatose after cardiac arrest continue to be a challenge, with high mortality. Although there is an American College of Cardiology Foundation/American Heart Association Class I recommendation for performing immediate angiography and percutaneous coronary intervention (when indicated) in patients with ST-segment elevation myocardial infarction, no guidelines exist for patients without ST-segment elevation. Early introduction of mild therapeutic hypothermia is an established treatment goal. However, there are no established guidelines for risk stratification of patients for cardiac catheterization and possible percutaneous coronary intervention, particularly in patients who have unfavorable clinical features in whom procedures may be futile and affect public reporting of mortality. An algorithm is presented to improve the risk stratification of these severely ill patients with an emphasis on consultation and evaluation of patients prior to activation of the cardiac catheterization laboratory.

Ad hoc percutaneous coronary intervention: a consensus statement from the Society for Cardiovascular Angiography and Interventions.

Percutaneous coronary interventions (PCI) may be performed during the same session as diagnostic catheterization (ad hoc PCI) or at a later session (delayed PCI). Randomized trials comparing these strategies have not been performed; cohort studies have not identified consistent differences in safety or efficacy between the two strategies. Ad hoc PCI has increased in prevalence over the past decade and is the default strategy for treating acute coronary syndromes. However, questions about its appropriateness for some patients with stable symptoms have been raised by the results of recent large trials comparing PCI to medical therapy or bypass surgery. Ad hoc PCI for stable ischemic heart disease requires preprocedural planning, and reassessment after diagnostic angiography must be performed to ensure its appropriateness. Patients may prefer ad hoc PCI because it is convenient. Payers may prefer ad hoc PCI because it is cost-efficient. The majority of data confirm equivalent outcomes in ad hoc versus delayed PCI. However, there are some situations in which delayed PCI may be safer or yield better outcomes. This document reviews patient subsets and clinical situations in which one strategy is preferable over the other.