IABP therapy is associated with higher mortality in patients undergoing PCI

An observational study involving Japanese patients undergoing PCI found the use of intra-aortic balloon pump (IABP) therapy was associated with a significantly higher risk of in-hospital mortality.

The researchers noted that 15.1 percent of patients receiving an IABP died in the hospital compared with 0.9 percent of patients who did not receive an IABP. Of the patients, only 6.7 percent received an IABP.

Lead researcher Taku Inohara, MD, PhD, of the Keio University School of Medicine in Tokyo, and colleagues published their results online in JAMA Internal Medicine on Nov. 2.

They wrote that the findings were consistent with a previous meta-analysis that found a negative association between mortality and IABP therapy in patients with acute MI.

“[The results] suggest that it is time to reconsider the appropriate use of IABP therapy, a potentially life-saving but extremely costly and high-risk intervention for patients,” they wrote.

The trial included 13,253 patients who underwent PCI between Sept. 2, 2008, and May 19, 2014, and were registered in a multicenter Japanese PCI registry.

Of the patients, 23.9 percent had PCIs after non-ST-segment elevation MI and 24.2 percent had PCIs after experiencing unstable angina. Before undergoing PCI, 3.7 percent of patients had complications of cardiogenic shock and 6.8 percent had serious heart failure, which was defined as New York Heart Association functional classification of 3 or higher.

After adjusting for baseline differences, the researchers found that IABP use remained an independent predictor of in-hospital mortality. The findings were consistent across all sub-groups, including patients who had indications for IABP use.

“Notably, the risk of death appeared to be higher (with higher odds ratios) as the indications for IABP use became less established,” the researchers wrote.

The researchers mentioned a few study limitations, including that the observational design meant they could not assume a causal relationship between IABP use and mortality. The registry they used also did not identify the reasons patients were treated with an IABP. They added that it was possible physicians or patients may have declined to use IABP.