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. 2016 Mar 16:10:297-312.
doi: 10.2147/PPA.S101945. eCollection 2016.

The outcomes of intra-aortic balloon pump usage in patients with acute myocardial infarction: a comprehensive meta-analysis of 33 clinical trials and 18,889 patients

Zhong-Guo Fan  1 , Xiao-Fei Gao  2 , Li-Wen Chen  1 , Xiao-Bo Li  2 , Ming-Xue Shao  2 , Qian Ji  1 , Hao Zhu  1 , Yi-Zhi Ren  1 , Shao-Liang Chen  2 , Nai-Liang Tian  2
Affiliations

The outcomes of intra-aortic balloon pump usage in patients with acute myocardial infarction: a comprehensive meta-analysis of 33 clinical trials and 18,889 patients

Zhong-Guo Fan et al. Patient Prefer Adherence. .

Abstract

Background: The effects of intra-aortic balloon pump (IABP) usage in patients with acute myocardial infarction remain controversial. This study sought to evaluate the outcomes of IABP usage in these patients.

Methods: Medline, EMBASE, and other internet sources were searched for relevant clinical trials. The primary efficacy endpoints (in-hospital, midterm, and long-term mortality) and secondary endpoints (reinfarction, recurrent ischemia, and new heart failure in the hospital) as well as safety endpoints (severe bleeding requiring blood transfusion and stroke in-hospital) were subsequently analyzed.

Results: Thirty-three clinical trials involving 18,889 patients were identified. The risk of long-term mortality in patients suffering from acute myocardial infarction was significantly decreased following IABP use (odds ratio [OR] 0.66, 95% confidence interval [CI]: 0.48-0.91, P=0.010). Both in-hospital and midterm mortality did not differ significantly between the IABP use group and no IABP use group (in-hospital: OR 0.87, 95% CI: 0.59-1.28, P=0.479; midterm: OR 1.12, 95% CI: 0.53-2.38, P=0.768). IABP insertion was not associated with the risk reduction of reinfarction, recurrent ischemia, or new heart failure. However, IABP use increased the risk of severe bleeding requiring blood transfusion (OR 2.05, 95% CI: 1.29-3.25, P=0.002) and stroke (OR 1.71, 95% CI: 1.04-2.82, P=0.035). In the thrombolytic therapy and cardiogenic shock subgroups, reduced mortality rates following IABP use were observed.

Conclusion: IABP insertion is associated with feasible benefits with respect to long-term survival rates in patients suffering from acute myocardial infarction, particularly those suffering from cardiogenic shock and receiving thrombolytic therapy, but at the cost of higher incidence of severe bleeding and stroke.

Keywords: acute myocardial infarction; cardiogenic shock; intra-aortic balloon pump; meta-analysis; thrombolytic therapy.

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Figures

Figure 1
Figure 1
A flowchart depicting the selection of the studies included in this meta-analysis.
Figure 2
Figure 2
Forest plots of the primary efficacy endpoint of the included trials. Notes: The odds ratio (OR) of in-hospital all-cause mortality (A), midterm all-cause mortality (B), and long-term all-cause mortality (C), associated with IABP use compared with no IABP use, stratified by different dual regimens. Weights are from random effects analysis. Abbreviations: CI, confidence interval; IABP, intra-aortic balloon pump; RCT, randomized controlled trial; ID, identification.
Figure 2
Figure 2
Forest plots of the primary efficacy endpoint of the included trials. Notes: The odds ratio (OR) of in-hospital all-cause mortality (A), midterm all-cause mortality (B), and long-term all-cause mortality (C), associated with IABP use compared with no IABP use, stratified by different dual regimens. Weights are from random effects analysis. Abbreviations: CI, confidence interval; IABP, intra-aortic balloon pump; RCT, randomized controlled trial; ID, identification.
Figure 3
Figure 3
Forest plots of the secondary efficacy endpoint of the included trials. Notes: The odds ratio (OR) of reinfarction (A), recurrent ischemia (B), and new heart failure (C) associated with IABP use versus no IABP use stratified by different dual regimens. Weights are from random effects analysis. Abbreviations: CI, confidence interval; IABP, intra-aortic balloon pump; RCT, randomized controlled trial; ID, identification.
Figure 3
Figure 3
Forest plots of the secondary efficacy endpoint of the included trials. Notes: The odds ratio (OR) of reinfarction (A), recurrent ischemia (B), and new heart failure (C) associated with IABP use versus no IABP use stratified by different dual regimens. Weights are from random effects analysis. Abbreviations: CI, confidence interval; IABP, intra-aortic balloon pump; RCT, randomized controlled trial; ID, identification.
Figure 4
Figure 4
Forest plots of the safety endpoints of the included trials. Notes: The odds ratio (OR) of severe bleeding requiring blood transfusion (A) and stroke (B) associated with IABP use versus no IABP use stratified by different dual regimens. Weights are from random effects analysis. Abbreviations: CI, confidence interval; IABP, intra-aortic balloon pump; RCT, randomized controlled trial; ID, identification.
Figure 5
Figure 5
Forest plots of the subgroup analysis of the included trials. Notes: The odds ratio (OR) of in-hospital all-cause mortality (A) and long-term all-cause mortality (B) among the patients suffering from AMI complicated by CS, as well as midterm all-cause mortality (C) and the long-term mortality associated with different opportunities of IABP insertion vs no IABP use (D) according to reperfusion strategy and IABP insertion associated with IABP use versus no IABP use stratified by different dual regimens. (C) #: Different groups of patients from the TACTICS trial received the corresponding reperfusion; ##: different groups of patients from the GUSTO-I trial received the corresponding reperfusion. Weights are from random effects analysis. Abbreviations: AMI, acute myocardial infarction; CI, confidence interval; ERV, emergency revascularization; TT, thrombolytic therapy; CS, cardiogenic shock; IABP, intra-aortic balloon pump; ID, identification; NA, not available.
Figure 5
Figure 5
Forest plots of the subgroup analysis of the included trials. Notes: The odds ratio (OR) of in-hospital all-cause mortality (A) and long-term all-cause mortality (B) among the patients suffering from AMI complicated by CS, as well as midterm all-cause mortality (C) and the long-term mortality associated with different opportunities of IABP insertion vs no IABP use (D) according to reperfusion strategy and IABP insertion associated with IABP use versus no IABP use stratified by different dual regimens. (C) #: Different groups of patients from the TACTICS trial received the corresponding reperfusion; ##: different groups of patients from the GUSTO-I trial received the corresponding reperfusion. Weights are from random effects analysis. Abbreviations: AMI, acute myocardial infarction; CI, confidence interval; ERV, emergency revascularization; TT, thrombolytic therapy; CS, cardiogenic shock; IABP, intra-aortic balloon pump; ID, identification; NA, not available.
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