Intra-Aortic Balloon Pumps Evaluated in High-Risk PCI

December 6, 2011—A study of the use and effectiveness of intra-aortic balloon pumps (IABPs) among patients undergoing high-risk percutaneous coronary intervention (PCI) was published by Jeptha P. Curtis, MD, et al online ahead of print in Circulation: Cardiovascular Quality and Outcomes.

The investigators noted that IABPs are frequently used to provide hemodynamic support during high-risk PCI, but clinical evidence to support their use is mixed.

In this study, the investigators examined hospital variation in IABP use among high-risk PCI patients, determined the association of IABP use on mortality in this population, and concluded that IABP use varied significantly across hospitals for high-risk PCI. However, this variation in IABP use was not associated with differences in in-hospital mortality.

As detailed in Circulation: Cardiovascular Quality and Outcomes, the investigators analyzed data submitted to the National Cardiovascular Data Registry's CathPCI Registry between January 2005 and December 2007. High-risk PCI was defined as having at least one of the following features: unprotected left main artery as the target vessel, cardiogenic shock, severely depressed left ventricular function, or ST-segment elevation myocardial infarction.

Hospitals were categorized into quartiles by their proportional use of IABPs. Differences in in-hospital mortality across hospital quartiles were examined using a hierarchical logistic regression model to adjust for differences in patient and hospital characteristics across hospital quartiles of IABP use.

The investigators reported that IABPs were used in 18,990 (10.5%) of 181,599 high-risk PCI procedures. Proportional use of IABPs varied significantly across hospital quartiles: Q1, 0.0% to 6.5%; Q2, 6.6% to 9.2%; Q3, 9.3% to 14.1%; Q4, 14.2% to 40%. In multivariable analysis, after adjustment for differences in patient and hospital characteristics, in-hospital mortality was comparable across quartiles of hospital IABP usage (Q1, Ref; Q2, odds ratio 1.11, 95% CI 0.99–1.24; Q3, odds ratio 1.03, 95% CI 0.92–1.15; Q4, odds ratio 1.06, 95% CI 0.94–1.18).