Use of Intra-aortic Balloon Pump Before Surgery for Acute Myocardial Infarction

Percutaneous coronary intervention (PCI) is the first treatment for myocardial ischemia; however, if left main coronary artery disease, multivessel disease, or complex architecture disable PCI, 10% of patients may need coronary artery bypass grafting (CABG). Abstinence from surgical reperfusion in patients with acute myocardial infarction (AMI) may be justified due to surgery's 50% mortality rate. An intra-aortic balloon pump (IABP) can help patients who have ongoing ischemia and high cardiac enzymes because it changes the way the heart uses oxygen by increasing coronary blood flow and lowering afterload. Some guidelines do not recommend the use of IABP in patients with AMI except for mechanical complications or shock. Nevertheless, it is commonly acknowledged that the specific criteria for employing IABP differ among clinics and are determined by clinical expertise. Patients with AMI who have impaired coronary perfusion and require surgical revascularization can benefit from preoperative intra-aortic balloon pump (IABP) support. This intervention leads to reorganization of coronary perfusion, resulting in a decrease in elevated troponin levels and quicker myocardial recovery.

• Intra-aortic Balloon Pump (Device), also known as Datascope Corp. model:The CS300 with IntelliSense combines fiber-optic: It will be applied to patients with acute myocardial infarction who have elevated troponin levels and recurrent or persistent chest pain at rest, hemodynamic instability, multivascular disease, left main coronary artery disease, and patients with narrow and/or tortuous coronary artery anatomy in whom PCI has failed or is not applicable.

Primary outcomes

• High-Sensitivity Cardiac Troponin Levels From Days 0-7 [0-7 days]: Daily repeated measurements of high-sensitivity cardiac troponin (hs-cTnI) on the ng/mL scale were compared between the two groups. The study hypothesizes that hs-cTnI levels decrease more rapidly in participants receiving IABP support compared to those without IABP. This decrease is posited to reflect a myocardial healing process.

Secondary outcomes

• In-hospital Mortality [0-30 days]: Deaths occurring in the first 30 days after the operation have been defined as mortality.

Sex: All, ages: 18 Years to 85 Years

Inclusion Criteria:

* Patients who have had acute myocardial infarction and have been decided on coronary surgical revascularization

Exclusion Criteria:

* mechanical complications of Acute Myocardial Infarction (such as a ruptured chordal or ventricular septum)
* peripheral arterial disease
* renal failure
* history of cerebrovascular accident
* acute cardiogenic shock and cardiac arrest
* reoperation and combined operations

Participant flow

Outcome results

• High-Sensitivity Cardiac Troponin Levels From Days 0-7 (Primary), Mean, ng/mL (0-0.04): Group A (IABP Support) 29.2 +/- 20.5; Group B (Control Group; Without IABP Support) 17.3 +/- 16.6 (p 0.05)
• In-hospital Mortality (Secondary), Count of participants, Participants: Group A (IABP Support) 4; Group B (Control Group; Without IABP Support) 7 (p <0.05)

Adverse events

Time frame: Adverse events were recorded during the period from the 1st to the 30th postoperative day for each patient who underwent coronary artery bypass grafting surgery

Serious adverse events by term

Other adverse events by term

Limitations and caveats: Not using more than one troponin test kit. The Swan-Ganz catheter or cardiac index device cannot be used in every patient.

• Study Protocol and Statistical Analysis Plan (PDF, 2021-05-01)
• Informed Consent Form (PDF, 2021-05-01)

• Ümit Arslan, assoc prof, Principal investigator, Ataturk University