IABP therapy in patients undergoing urgent coronary artery bypass grafting for acute coronary syndrome

Objectives: Patients with acute coronary syndrome (ACS) undergoing urgent on-pump coronary artery bypass grafting (CABG) are at increased risk for postcardiotomy cardiac failure. This study investigated the importance of intra-aortic balloon pump (IABP) support in this high-risk patient cohort with special focus on timing of IABP therapy.

Methods: Patients with ACS and urgent indication for on-pump coronary artery bypass grafting (CABG) were retrospectively analysed. IABP support was either implemented by the cardiologist/surgeon before or after CABG. The impact of IABP support on clinical outcomes was assessed, including in-hospital mortality and major adverse cardiac events (MACE).

Results: From April 2010 to August 2011 a total of 192 patients with ACS underwent urgent CABG in our institution. IABP therapy was employed in 26% (50/192) for a mean duration of 68±44 hours. Patients with IABP support presented more often with a critical preoperative status when compared to control (cardiogenic shock 48% vs. 3%; STEMI 66% vs. 20%; EF <50% 72% vs. 32%; preoperative CPR 30% vs. 3%, p<0.05 for all) and in-hospital mortality was higher in the IABP group (IABP 32% vs. no IABP 4%, p<0.001). Importantly, preoperative IABP therapy resulted in lower in-hospital mortality compared to delayed (i.e. intra-/postoperative) initiation of IABP support (0% vs. 43%, p=0.004), despite compromised preoperative status of patients in the preoperative IABP group (cardiogenic shock 77% vs. 38%, p=0.024; preoperative CPR 62% vs. 19%, p=0.011).

Conclusions: Preoperative implementation of IABP therapy confers significant benefits for clinical outcomes in high-risk patients undergoing urgent CABG for ACS.