Med J Chin PLA, Vol. 41, No. 6, June 1, 2016 441 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 [ ] [ ] R542.22 [ ] A [ ] 0577-7402(2016)06-0441-05 [DOI] 10.11855/j.issn.0577-7402.2016.06.02 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 110016, China 2 Department of Cardiology, 306 Hospital of PLA, Beijing 100101, China 3 Department of Cardiology, General Hospital of Chinese People's Armed Police Force, Beijing 100039, China 4 Department of Cardiology, Navy General Hospital of PLA, Beijing 100048, China 5 Department of Cardiology, Urumqi General Hospital of Lanzhou Military Command, Urumqi 830000, China 6 Department of Cardiology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China 7 Department of Cardiology, Shaanxi Provincial Corps Hospital, Chinese People's Armed Police Forces, Xi'an 710054, China 8 Department of Cardiology, 91 Hospital of PLA, Jiaozuo, Henan 510320, China 9 Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing 400042, China 10 Department of Cardiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China 11 Department of Cardiology, 97 Hospital of PLA, Xuzhou, Jiangsu 221000, China 12 Department of Cardiology, 451 Hospital of PLA, Xi'an 710054, China 13 Department of Cardiology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou 350025, China [ ] [ ] 110016 () 100101 306( ) 100039( ) 100048( ) 830000( ) 710038 ( ) 710054 ( ) 510320 91( ) 400042 ( ) 400038 ( ) 221000 97( ) 710054451( ) 350025 ( ) 200003 ( ) 116021 210( ) 214000 101( ) 030001264( ) [ ] E-mail hanyaling@263.net
442 2016 6 1 41 6 14 Department of Cardiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China 15 Department of Cardiology, 210 Hospital of PLA, Dalian, Liaoning 116021, China 16 Department of Cardiology, 101 Hospital of PLA, Wuxi, Jiangsu 214000, China 17 Department of Cardiology, 264 Hospital of PLA, Taiyuan 030001, China * Corresponding author, E-mail: 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 1 1.1 (http://www.xxgjr. com) 2010 10 1.2 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<0.05 2 2.1 2010 10
Med J Chin PLA, Vol. 41, No. 6, June 1, 2016 443 2013 8 92 8878 STEMI7137 1741 60.8±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±12.2 60.5±12.4 0.000 Male [n(%)] 593(19.0) 6544(80.3) 0.659 Hyperlipaemia [n(%)] 144(19.7) 1848(22.7) 0.061 Hypertension [n(%)] 305(41.7) 3937(48.3) 0.001 Smoking history[n(%)] 234(32.0) 3148(38.6) 0.000 Family history [n(%)] 14(1.9) 206(2.5) 0.304 Old myocardial infarction [n(%)] 271(37.0) 3086(37.9) 0.645 Heart failure [n(%)] 51(7.0) 336(4.1) 0.000 Renal dysfunction [n(%)] 9(1.2) 73(0.9) 0.366 Cerebral vascular disease [n(%)] 54(7.4) 384(4.7) 0.001 Peripheral vascular disease [n(%)] 8(1.1) 46(0.6) 0.083 Chronic lung disease [n(%)] 8(1.1) 93(1.1) 0.905 Diabetes [n(%)] 137(18.7) 1450(17.8) 0.536 Hemodialysis treatment [n(%)] 1(0.1) 9(0.1) 0.577 History of valvular surgery [n(%)] 27(3.7) 410(5.0) 0.107 HistoryofPCI[n(%)] 55(7.5) 623(7.6) 0.896 HistoryofCABG[n(%)] 11(1.5) 293(3.6) 0.003 Door-to-balloon time (h) 1.21±2.57 1.26±1.85 0.544 Symptom-onset-to-balloon time (h) 5.67±4.25 5.94±4.32 0.105 Target vessel number [n(%)] 0.000 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) 0.000 2.2 - 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±12.2 63.5±11.6 0.537 Male [n(%)] 591(81.1) 589(80.8) 0.894 Hyperlipaemia [n(%)] 144 (19.8) 158(21.7) 0.366 Hypertension [n(%)] 304 (41.7) 302(41.4) 0.915 Smoking history [n(%)] 234(32.1) 220(30.2) 0.428 Family history [n(%)] 14(1.9) 12(1.6) 0.692 Old myocardial infarction [n(%)] 268(36.8) 271(37.2) 0.871 Heart failure [n(%)] 48(6.6) 53(7.3) 0.606 Renal dysfunction [n(%)] 9(1.2) 8(1.1) 0.807 Cerebral vascular disease [n(%)] 7(1.0) 5(0.7) 0.562 Peripheral vascular disease [n(%)] 7(1.0) 5(0.7) 0.562 chronic lung disease [n(%)] 8(1.1) 10(1.4) 0.635 Diabetes [n(%)] 136(18.7) 153(21.0) 0.293 Hemodialysis treatment [n(%)] 1(0.1) 0(0) 1.000 History of valvular surgery [n(%)] 27(3.7) 25(3.4) 0.778 HistoryofPCI[n(%)] 54(7.4) 64(8.8) 0.337 HistoryofCABG[n(%)] 11(1.5) 14(1.9) 0.545 Door-to-balloon time (h) 1.21±2.57 1.31±1.85 0.396 Symptom-onset-to-balloon time (h) 5.68±4.25 6.03±4.57 0.128 Target vessel number [n(%)] 0.867 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) 0.488 3(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) 0.164 In-hospital mortality 76(10.4) 18(2.5) 0.000 Stent thrombosis 8(1.1) 2(0.3) 0.057 Postoperative bleeding 5(0.7) 3(0.4) 0.726 PCI CABG IABP logistic ( 4) 3 STEMI STEMI IABP STEMI
444 2016 6 1 41 6 4logistic Tab.4 Predictors of in-hospital mortality: multivariate analysis Variable OR 95% CI P value Age 1.033 1.012,1.055 0.002 Male 0.509 0.301,0.863 0.012 Hypertension 0.823 0.516,1.312 0.413 Smoking history 1.341 0.802,2.242 0.263 Family history 1.424 0.291,6.963 0.663 Heart failure 3.822 2.086,7.005 0.000 Diabetes 1.479 0.869,2.515 0.149 Renal dysfunction 5.124 1.493,17.581 0.009 History of valvular surgery 0.827 0.164,4.179 0.818 History of PCI 0.961 0.388,2.379 0.932 History of CABG 1.714 0.163,18.058 0.654 Door-to-balloon time 0.997 0.904,1.098 0.945 Target vessel number 0.512 0.311,0.844 0.009 Peri-procedural tirofiban use 0.726 0.466,1.132 0.158 IABP 5.075 2.962,8.696 0.000 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=0.000 0.001) (55.6% vs 34.5% P =0.000) (60.7% vs 50.7% P=0.000) IABP 1:1 logistic 20 2203 65 [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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