Debate: Mechanical circulatory support in relation to coronary intervention. The interventional cardiologist perspective

Abstract

QUESTION: After the IABP-SHOCK II clinical trial, which would you say is the utility of the intra-aortic balloon pump (IABP)? ANSWER: In my opinion and yet despite the results of the IABP-SHOCK II,1 the intra-aortic balloon pump (IABP) still plays a significant role in the management of acute myocardial infarction (AMI) and complex percutaneous coronary intervention (PCI) with risks higher than normal. In high-risk PCIs there is evidence of the benefits derived from using left ventricular assist devices. In the first place, the IABP has shown late benefits in the BCIS-I trial.2 This study randomized patients treated with high-risk PCI—defined as a left ventricular ejection fraction < 30% and > 40% of the lesion related myocardium with intention-to-treat—assessed using scores ≥ 8 in the Jeopardy score. The early study found no significant differences in the primary endpoint at the 28-day follow-up. In the secondary endpoint a numerical difference was found in the mortality rate at the 6-month follow-up, although it was not statistically significant (4.6 in the IABP vs 7.4% in the control group; P = .32) probably due to the low number of patients included (301). However, at the 51-month follow-up,3 the mortality rate was significantly higher in the control group:...