Experience of using an intra-aortic balloon counterpulsator as a "bridge" to coronary bypass surgery in acute coronary syndrome without high-risk ST elevation

• Golovina T.S.
• Yuliya N. Neverova
• Nishonov A.B.
• Kozirin K.A.
• Ivkin A.A.
• Roman S. Tarasov

Abstract

Background. The time interval for performing surgery in patients with acute coronary syndrome without ST segment elevation is important for achieving optimal treatment results, in this regard, the use of an intra-aortic balloon counterpulsator seems promising.

Aim. To assess the incidence of adverse cardiovascular events during the hospital follow-up period in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) with high-risk multivessel disease, depending on the use of an intra-aortic balloon counterpulsator (IABP) in the preoperative period as a "bridge" to coronary artery bypass grafting (CABG).

Material and methods. In a study within the framework of a one-center register, two groups were compared with the use of IABA in the preoperative period (n=21) and without it (n=60). Adverse cardiovascular events were determined as death, myocardial infarction, acute cerebrovascular accident/transient ischemic attack, clinically significant bleeding according to the BARC scale. 

Results. According to the results of the analysis, the groups were comparable in terms of the main clinical and demographic characteristics. There were no significant differences in the SYNTAX and GRACE scales (p=0.08 and p=0.23, respectively). Within the first 12 hours from the moment of admission, CABG was more often performed in the IABC-CABG group - 42.85%, compared with the group of isolated CABG (20%) (p=0.05). Within 12-24 hour interval, CABG in the IABC-CABG and CABG groups was performed in 57.14 and 50% of cases (p=0.032) and more within 24 hours - 0 and 30%, respectively. The lethal outcome was more often observed in the IABC-CABG group, 14.28% compared with 5% in the CABG group (p<0.001). For other unfavorable cardiovascular events: MI (p=0.26), stroke (p=0.45), severity of blood loss on the BARC type 4 scale (p=0.11) and sepsis (p=0.76) there was no obtained significant differences.

Conclusion. The obtained results showed that the use of IABP in NSTE-ACS patients with a high risk of IABP is associated with an initially higher surgical risk on the EuroScore II scale, a reduced <40% LVEF, more common multifocal atherosclerosis, and is associated with a higher risk of mortality in the hospital period when performing emergency CABG surgery. Nevertheless, the hospital results of treatment of this extremely difficult group of patients with the use of IABC and urgent CABG surgery seem to be satisfactory.

Keywords:high-risk non-ST elevation acute coronary syndrome, intra-aortic balloon counterpulsation, emergency coronary artery bypass grafting

References

1. Anderson M.L., Peterson E.D., Peng S.A., Wang T.Y., Ohman E.M., Bhatt D.L., et al. Differences in the profile, treatment, and prognosis of patients with cardiogenic shock by myocardial infarction classification: a report from NCDR. Circ Cardiovasc Qual Outcomes. 2013; 6 (6): 708-15. PMID: 24221834. DOI: https://doi.org/10.1161/CIRCOUTCOMES.113.000262

2. Neverova Yu.N., Golovina T.S., Tarasov R.S. Intraaortic balloon counterpulsation: current evidence-based and unresolved issues. Patologiya krovoobrashcheniya i kardiokhirurgiya [Pathology of Blood Circulation and Cardiac Surgery]. 2020; 24 (3S): 18-32. DOI: https://doi.org/10.21688/1681-3472-2020-3S-18-32  (in Russian)

3.    Kucuker A., Cetin L., Kucuker S.A., Gokcimen M., Hidiroglu M., Kunt A., et al. Single-centre experience with perioperative use of intraaortic balloon pump in cardiac surgery. Heart Lung Circ. 2014; 23: 475-81. DOI: https://doi.org/10.1016/j.hlc.2013.11.005

4.    Patrono C., Collet J.-Ph., Mueller Ch., et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2016; 37 (3): 267-315. DOI: https://doi.org/10.1093/eurheartj/ehv320

5. Liu F., Yang F., Du Z. Timing of intra-aortic balloon pump placement before off-pump coronary artery bypass grafting and clinical outcomes. Artif Organs. 2018; 42 (3): 263-70. DOI: https://doi.org/10.1111/aor.13009 Epub 2017 Nov 8.

6.    Liakopoulos O.J., Schlachtenberger G., Wendt D., Yeong-Hoon Choi. Early clinical outcomes of surgical myocardial revascularization for acute coronary syndromes complicated by cardiogenic shock: a report from the North-Rhine-Westphalia Surgical Myocardial Infarction Registry. J Am Heart Assoc. 2019; 8 (10): e012049. DOI: https://doi.org/10.1161/JAHA.119.012049

7.    Ding W., Ji Q., Wei Q., Shi Y., Ma R., Wang C. Prophylactic application of an intra-aortic balloon pump in high-risk patients undergoing off-pump coronary artery bypass grafting. Cardiology. 2015; 131: 109-15. DOI: https://doi.org/10.1159/000377720

8.    Poirier Y., Voisine P., Plourde G., Rimac G. Efficacy and safety of preoperative intra-aortic balloon pump use in patients undergoing cardiac surgery: a systematic review and meta-analysis. Int J Cardiol. 2016; 207: 67-79. DOI: https://doi.org/10.1016/j.ijcard.2016.01.045 Epub 2016 Jan 7.

9.    Ranucci M., Castelvecchio S., Biondi A. A randomized controlled trial of preoperative intra-aortic balloon pump in coronary patients with poor left ventricular function undergoing coronary artery bypass surgery. Crit Care Med. 2013; 41 (11): 2476-83. DOI: https://doi.org/10.1097/CCM.0b013e3182978dfc

10.    Hemo E., Medalion B., Mohr R. Long-term outcomes of coronary artery bypass grafting patients supported preoperatively with an intra-aortic balloon pump. J Thorac Cardiovasc Surg. 2014; 148 (5): 1869-75. DOI: https://doi.org/10.1016/jjtcvs.2013.12.063 Epub 2014 Jan 15

11. Christenson J.T., Licker M., Kalangos A. The role of intra-aortic counterpulsation in high-risk OPCAB surgery: a prospective randomized study. J Card Surg. 2003; 18:    286-94. DOI: https://doi.org/10.1046/j.1540-8191.2003.02030.x

12.    Schumer E.M., Chaney J.H., Trivedi J.R. Emergency coronary artery bypass grafting: indications and outcomes from 2003 through 2013. Tex Heart Inst J. 2016; 43 (3): 214-9. DOI: https://doi.org/10.14503/THIJ-14-4978

13.    Zangrillo A., Pappalardo F., Dossi R. Preoperative intra-aortic balloon pump to reduce mortality in coronary artery bypass graft: a meta-analysis of randomized controlled trials. Crit Care. 2015; 19 (1): 10. DOI: https://doi.org/10.1186/s13054-014-0728-1  Epub 2015 Jan 14.

14. Barbarash L.S., Ganyukov V.I., Popov V.A., Tarasov R.S., Torgunakov S.A., Kochergin N.A., et al. Hospital results of treatment of acute coronary syndrome without ST-segment elevation in multivessel coronary artery disease, depending on the method and strategies of revascularization. Kardiologicheskiy vestnik [Annals of Cardiology]. 2013; 8 [2 (20)]: 17-22. (in Russian)

15.    Rojas S.V., Trinh-Adams M.L., Uribarri A. Early surgical myocardial revascularization in non-ST-segment elevation acute coronary syndrome. J Thorac Dis. 2019; 11 (11): 4444-52. DOI: https://doi.org/10.21037/jtd.2019.11.08

16.    Collet J.P., Thiele H., Barbato E., Barthelemy O., Bauersachs J., Bhatt D.L., et al.; ESC Scientific Document Group. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020; Aug 29: ehaa575. DOI: https://doi.org/10.1093/eur-heartj/ehaa575 PMID: 32860058.

17.    Deppe A., Weber C., Liakopoulos O. 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. J Card Surg. 2017; 32 (3): 177-85. DOI: https://doi.org/10.1111/jocs.13114

18.    Mehlhorn U., Kroner A., de Vivie E.R. 30 years clinical intra-aortic balloon pumping: facts and figures. Thorac Cardiovasc Surg. 1999; 47 (suppl 2): 298-303. DOI: https://doi.org/10.1055/s-2007-1012052

19.    Vereschagin I.E., Ganyukov V.I., Kochergin N.A., Korneluk R.A., Barbarash O.L. The results of percutaneous intervention in acute coronary syndrome depending on the type of mechanical hemodynamic support of blood circulation. Patologiya krovoobrashcheniya i kardiokhirurgiya [Pathology of Blood Circulation and Cardiac Surgery]. 2019; 23 (1S): S34-S43. DOI: https://doi.org/10.21688/1681-347 2-2019-1S-S34-S43  (in Russian)

20.    Caldas J.R., Panerai R.B., Bor-Seng-Shu E. Intraaortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: an analysis of the IABCS trial. Ann Intensive Care. 2019; 9: 130. DOI: https://doi.org/10.1186/s13613-019-0602-z

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