ST PCI 8878 STEMI. [DOI] /j.issn Med J Chin PLA, Vol. 41, No. 6, June 1, [ ]

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1 Med J Chin PLA, Vol. 41, No. 6, June 1, ST [ ] ST (STEMI) (IABP) PCI 8878 STEMI IABP IABP (732 ) (8146 ) IABP1:1 logistic 1:1 (P>0.05) IABP (10.4% vs 2.5% P<0.05) IABP STEMI [ ] [ ] R [ ] A [ ] (2016) [DOI] /j.issn Effects of IABP on patients with acute ST-elevated myocardial infarction HONG Tai-lian 1, XU Kai 1, JING Quan-min 1, WANG Shou-li 2, LIU Hui-liang 3, LI Tian-chang 4, GAN Ji-hong 5, ZHENG Qiang-sun 6, YANG Xing-chang 7, REN Jiang 8, ZENG Chun-yu 9, SONG Zhi-yuan 10, XIANG Jun 11, TUO Bu-xiong 12, LUO Zhu-rong 13, LIANG Chun 14, JIANG Dong-ju 15, ZONG Gang-jun 16, WU Li-jun 17, BAI Shu-yi 1, TIAN Xiao-xiang 1, HAN Ya-ling 1* 1 Department of Cardiology, General Hospital of Shenyang Military Command, Shenyang , China 2 Department of Cardiology, 306 Hospital of PLA, Beijing , China 3 Department of Cardiology, General Hospital of Chinese People's Armed Police Force, Beijing , China 4 Department of Cardiology, Navy General Hospital of PLA, Beijing , China 5 Department of Cardiology, Urumqi General Hospital of Lanzhou Military Command, Urumqi , China 6 Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an , China 7 Department of Cardiology, Shaanxi Provincial Corps Hospital, Chinese People's Armed Police Forces, Xi'an , China 8 Department of Cardiology, 91 Hospital of PLA, Jiaozuo, Henan , China 9 Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing , China 10 Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing , China 11 Department of Cardiology, 97 Hospital of PLA, Xuzhou, Jiangsu , China 12 Department of Cardiology, 451 Hospital of PLA, Xi'an , China 13 Department of Cardiology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou , China [ ] [ ] () ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) [ ] hanyaling@263.net

2 Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai , China 15 Department of Cardiology, 210 Hospital of PLA, Dalian, Liaoning , China 16 Department of Cardiology, 101 Hospital of PLA, Wuxi, Jiangsu , China 17 Department of Cardiology, 264 Hospital of PLA, Taiyuan , China * Corresponding author, hanyaling@263.net [Abstract] Objective To evaluate the clinical efficacy and safety of intra-aortic balloon pump (IABP) counterpulsation for the patients with acute ST-elevated myocardial infarction (STEMI). Methods To retrospectively analyze the data collected from the Management System of Cardiovascular Interventional Treatment in Military Hospitals. A total of 8878 consecutive patients with acute STEMI undergoing percutaneous coronary intervention (PCI) were recruited in present study, of whom 732 patients received IABP therapy were assigned into IABP group and the other 8146 patients received no IABP into control group. Contrastive analysis was performed to analyze the baseline data of the two groups, and 1:1 propensity matching was done to compare the differences between the two groups of intraoperative mortality, in-hospital mortality, stent thrombosis and postoperative hemorrhage. Results Multi-logistic regression revealed that age, heart failure and renal dysfunction were the risk factors for in-hospital mortality. By 1:1 propensity matching analysis, no statistical differences were found between the two groups in intraoperative mortality, postoperative hemorrhage and stent thrombosis, and the in-hospital mortality was higher in IABP group than in control group (10.4% vs 2.5%, P<0.05). Conclusion IABP can't reduce the in-hospital mortality of patients with STEMI. [Key words] myocardial infarction; counterpulsation; hospital mortality ST (STEMI) 40%~50% [1-2] STEMI STEMI (intra-aortic balloon pump IABP) [3-4] [5-6] (extracorporeal membrane oxygenation ECMO) (paracorporealventricular assist device PVAD) [7] IABP STEMI IABP ( com) STEMI STEMI [6] () 1 99 ( )1 ST Q ST PCI 8878 STEMI IABP IABP (732 ) (8146 ) SPSS IABP PCI (CABG) (1 ) IABP1:1 1.3 SPSS 21.0 x±s t (%) χ 2 1:1 logistic P<

3 Med J Chin PLA, Vol. 41, No. 6, June 1, STEMI ±13.4(17~96) IABP IABP (n=732) (n=8146) (1 ) CABG (P<0.05) 1 1 Tab.1 BaselinedataofpatientsinIABPandcontrolgroup IABP (n=732) Non-IABP (n=8146) P value Age (year) 63.2± ± Male [n(%)] 593(19.0) 6544(80.3) Hyperlipaemia [n(%)] 144(19.7) 1848(22.7) Hypertension [n(%)] 305(41.7) 3937(48.3) Smoking history[n(%)] 234(32.0) 3148(38.6) Family history [n(%)] 14(1.9) 206(2.5) Old myocardial infarction [n(%)] 271(37.0) 3086(37.9) Heart failure [n(%)] 51(7.0) 336(4.1) Renal dysfunction [n(%)] 9(1.2) 73(0.9) Cerebral vascular disease [n(%)] 54(7.4) 384(4.7) Peripheral vascular disease [n(%)] 8(1.1) 46(0.6) Chronic lung disease [n(%)] 8(1.1) 93(1.1) Diabetes [n(%)] 137(18.7) 1450(17.8) Hemodialysis treatment [n(%)] 1(0.1) 9(0.1) History of valvular surgery [n(%)] 27(3.7) 410(5.0) HistoryofPCI[n(%)] 55(7.5) 623(7.6) HistoryofCABG[n(%)] 11(1.5) 293(3.6) Door-to-balloon time (h) 1.21± ± Symptom-onset-to-balloon time (h) 5.67± ± Target vessel number [n(%)] Single-disease 169(23.1) 3157(38.8) Double-disease 156(21.3) 2182(26.8) Triple-disease 407(55.6) 2807(34.5) Peri-procedural tirofiban use [n(%)] 444(60.7) 4126(50.7) PCI CABG (1 ) IABP 1:1 ( 729 ) 2 1:1 (P>0.05) IABP (10.4%)(2.5%) (P<0.05 3) 2.3 logistic 1:1 (1 ) 2 1:1 Tab.2 BaselinedataofpatientsinIABPandcontrolgroup after 1:1 propensity matching IABP (n=729) Non-IABP (n=729) P value Age (year) 63.1± ± Male [n(%)] 591(81.1) 589(80.8) Hyperlipaemia [n(%)] 144 (19.8) 158(21.7) Hypertension [n(%)] 304 (41.7) 302(41.4) Smoking history [n(%)] 234(32.1) 220(30.2) Family history [n(%)] 14(1.9) 12(1.6) Old myocardial infarction [n(%)] 268(36.8) 271(37.2) Heart failure [n(%)] 48(6.6) 53(7.3) Renal dysfunction [n(%)] 9(1.2) 8(1.1) Cerebral vascular disease [n(%)] 7(1.0) 5(0.7) Peripheral vascular disease [n(%)] 7(1.0) 5(0.7) chronic lung disease [n(%)] 8(1.1) 10(1.4) Diabetes [n(%)] 136(18.7) 153(21.0) Hemodialysis treatment [n(%)] 1(0.1) 0(0) History of valvular surgery [n(%)] 27(3.7) 25(3.4) HistoryofPCI[n(%)] 54(7.4) 64(8.8) HistoryofCABG[n(%)] 11(1.5) 14(1.9) Door-to-balloon time (h) 1.21± ± Symptom-onset-to-balloon time (h) 5.68± ± Target vessel number [n(%)] Single-disease 169(23.2) 164(22.5) Double-disease 156(21.4) 164(22.5) Triple-disease 404(55.4) 401(55.0) Peri-procedural tirofiban use [n(%)] 441(60.5) 428(58.7) (1:1) [n(%)] Tab.3 Comparison of intraoperative mortality, in-hospital mortality, stent thrombosis and postoperative hemorrhage betweenthetwogroupsin1:1 propensity matching data [n(%)] IABP (n=729) non-iabp (n=729) P value Intraoperative mortality 9(1.2) 4(0.5) In-hospital mortality 76(10.4) 18(2.5) Stent thrombosis 8(1.1) 2(0.3) Postoperative bleeding 5(0.7) 3(0.4) PCI CABG IABP logistic ( 4) 3 STEMI STEMI IABP STEMI

4 logistic Tab.4 Predictors of in-hospital mortality: multivariate analysis Variable OR 95% CI P value Age , Male , Hypertension , Smoking history , Family history , Heart failure , Diabetes , Renal dysfunction , History of valvular surgery , History of PCI , History of CABG , Door-to-balloon time , Target vessel number , Peri-procedural tirofiban use , IABP , IABP-SHOCK IABP [2,8-10] [11] 2013 / (ACCF/AHA) STEMI STEMI IABP a [12] 2014 (ESC) IABP / STEMI ( a) [13] 2015 STEMI IABP [14] IABP STEMI PCI[ (PTCA)] STEMI 8878 IABP IABP IABP (63.2±12.2 vs 60.5±12.4 P=0.000) (7.0% vs 4.1% 7.4% vs 4.7% P= ) (55.6% vs 34.5% P =0.000) (60.7% vs 50.7% P=0.000) IABP 1:1 logistic [15] IABP IABP (1: 1 ) IABP (1.2% vs 0.5% P=0.164) (1.1% vs 0.3% P=0.057) (0.7% vs 0.4% P=0.726) (10.4% vs 2.5% P=0.000) IABP-SHOCK [2] 600 IABP (n=301) (n=299) (3.3% vs 4.4% P=0.51) (1.3% vs 1.0% P=0.71) 30d (39.7% vs 41.3 P=0.69) IABP-SHOCK PCI( PTCA) STEMI IABP- SHOCK ( STEMI ST ) 95.8% PCI 3.5% CAGB 3.2% IABP IABP IABP-SHOCK IABP 13 IABP30 IABP IABP IABP IABP [16] Killip IABP [2,9,17-18] IABP

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