Interv Akut Kardiol. 2013;12(3):130-134

Intraaortic balloon counterpulsation in clinical cardiology

Karel Kopřiva, Petr Ošťádal, Martin Mates, Petr Neužil

Kardiologické oddělení, Komplexní kardiovaskulární centrum, Nemocnice Na Homolce, Praha

Intraaortic balloon counterpulsation (IABC) is the most common method of mechanical circulatory support and it has been used in

clinical settings for more than four decades. The widespread use of IABC was based mainly on its favourable hemodynamic effects and

observational data. The majority of studies analysing the effect of IABC in ST-elevation myocardial infarction (STEMI) without cardiogenic

shock did not show an efficacy benefit. The recent randomised CRISP AMI trial could not demonstrate a reduction of infarct size

in patients with STEMI without shock and IABC placement as adjunctive treatment to primary percutaneous coronary intervention (PCI).

In recent meta-analyses, IABC in STEMI complicated by cardiogenic shock was associated with decreased mortality in patients treated

with thrombolysis, whereas in patients undergoing primary PCI this beneficial effect of IABC was not observed. In the IABP-SHOCK

II trial, the use of IABC did not significantly reduce 30-day mortality in cardiogenic shock complicating myocardial infarction (MI) treated

with early revascularization. In the BCIS-1 trial, elective IABC use during high-risk PCI was associated with reduction in all-cause mortality.

According to current data, routine IABC use in unselected MI patients treated by primary PCI cannot be recommended. In contrast, elective

IABC use during high-risk PCI and in thrombolysed STEMI patients seems promising in terms of mortality reduction. Other studies

are needed to elucidate the role of IABC in cardiogenic shock.

Keywords: intraaortic balloon counterpulsation, myocardial infarction, cardiogenic shock, percutaneous coronary intervention

Published: May 15, 2013  Show citation