Premium
Preoperative intra‐aortic balloon pump use in high‐risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality—A meta‐analysis of 9,212 patients
Author(s) -
Deppe AntjeChristin,
Weber Carolyn,
Liakopoulos Oliver J.,
Zeriouh Mohamed,
Slottosch Ingo,
Scherner Maximilian,
Kuhn Elmar W.,
Choi YeongHoon,
Wahlers Thorsten
Publication year - 2017
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.13114
Subject(s) - medicine , intra aortic balloon pump , randomized controlled trial , myocardial infarction , odds ratio , cardiology , relative risk , meta analysis , intensive care unit , surgery , confidence interval , clinical endpoint , coronary artery bypass surgery , artery , cardiogenic shock , intra aortic balloon pumping
AIMS Prophylactic intra‐aortic balloon pump (IABP) support for high‐risk patients before coronary artery bypass grafting (CABG) is controversial. This meta‐analysis sought to determine the current role of preoperative IABP support. METHODS We performed a meta‐analysis of randomized (RCT) and observational trials (OT) that fulfilled the following criteria: (1) Group comparison of patients with prophylactic IABP implantation before CABG with a control group; (2) reporting at least one desired clinical endpoint, including all‐cause mortality, myocardial infarction, cerebrovascular accident (CVA), and renal failure. Pooled treatment effects (odds ratio [OR] or weighted mean difference, and 95% confidence intervals [95%CI]) were assessed using a fixed or random effects model. RESULTS A total of 9,212 patients from 23 studies (7 RCT, 16 OT) were identified after a literature search of major databases using a predefined keyword list. Absolute risk reduction for mortality in RCTs was 4.4% (OR 0.43; 95%CI 0.25‐0.73; p = 0.0025). Prophylactic IABP use before CABG surgery also decreased the risk for myocardial infarction (OR 0.58; 95%CI 0.43‐0.78; p = 0.004), CVA (OR 0.67; 95%CI 0.47‐0.97; p = 0.042), and renal failure (OR 0.62; 95%CI 0.47‐0.83; p = 0.0014). Length of intensive care unit stay (p < 0.0001) and length of hospital stay (p < 0.0001) were significantly reduced in patients with preoperative IABP use. CONCLUSION Current evidence from RCT and OT suggests beneficial effects for the IABP in high‐risk patients before CABG surgery.