The findings were published online today in the Journal of the American Medical Association (JAMA), and presented at the European Society of Cardiology in Paris, France.
The intra-aortic balloon pump works by increasing the blood supply to the heart, which reduces the heart's workload. According to Manesh Patel, M.D., the principal investigator and cardiologist at the Duke Clinical Research Institute (DCRI), "animal studies had suggested that inserting a balloon pump before opening the vessel would reduce the heart's workload and by doing so, could potentially reduce infarct size When we tested this observation in humans, we did not show an infarct reduction."
CRISP AMI was a multi-center, prospective, randomized trial that enrolled patients with acute ST-segment elevation myocardial infarction (STEMI) without shock within six hours of chest pain onset and planned primary percutaneous coronary intervention (PCI). Of the 337 patients enrolled, 161 were randomized to receive intra-aortic balloon counterpulsation (IABC) prior to primary PCI, and 176 to the standard of care (SOC), which is primary PCI without IABC support.
The mean infarct size, measured using cardiac magnetic resonance imaging, was not significantly different between the IABC and SOC groups (42.1% vs. 37.5%). At 30 days, major bleeding or transfusion occurred in 5 (3.1%) of the IABC patients versus 3 (1.7%) of SOC patients. Major vascular complications occurred in 7 (4.3%) of the IABC patients, versus 2 (1.1%) of the SOC patients. treated with IABC compared to SOC. By six months, death occurred in 3 (1.9%) in the IABC group and 9 (5.2%) in the SOC group.
While the study was not set up to report clinical events, the researchers say the results are interesting because they offer unique insight into treating AMI patients.
"The most striking observation is the excellent overall outcome for the highest-risk patients within the context of this trial," says E. Magnus Ohman, M.D., a co-investigator and cardiologist at DCRI. "The IABC group had less than five percent mortality. It's hard to improve that. We've gotten very good at treating AMI patients."
Acute myocardial infarction patients represent nearly half of the approximately 1.5 million annual hospitalizations for acute coronary syndromes in the U.S. Acute mortality risk is between 6% and 15%; one-year mortality is estimated at 38% for women and 25% for men.
Ohman says it's also important to note that 15 of the patients in the standard of care group crossed over to receive IABC – five prior to PCI and 10 after.
"While routine use of IABC is not recommended, physicians should be vigilant about identifying patients who are at risk for rapid deterioration and may benefit from counterpulsation," says Patel.
Funding for CRISP AMI was provided by Maquet/Datascope.
Manesh Patel, M.D., receives research grants and support from Maquet/Datascope.
Co-authors of this paper include Richard W. Smalling, M.D. Ph.D, Memorial Hermann Heart and Vascular Institute, University of Texas, Houston, TX;Holger Thiele, M.D., University of Leipzig-Heart Center, Leipzig, Germany; Huiman X. Barnhart, Ph.D. and Yi Zhou, Ph.D, DCRI; Praveen Chandra, M.D., Medanta–The Medicity, Haryana, India; Derek Chew, M.D., Flinders Medical Center, Bedford Park, Australia; Marc Cohen, M.D., Newark Beth Israel Medical Center, Newark, NJ; John French, MB, CHB, Ph.D., Liverpool Hospital, Liverpool, Australia; and Divaka Perera, M.D., Kings College, London, UK.
Debbe Geiger | EurekAlert!
New bioimaging technique is fast and economical
21.08.2017 | Rensselaer Polytechnic Institute
Noninvasive eye scan could detect key signs of Alzheimer's years before patients show symptoms
18.08.2017 | Cedars-Sinai Medical Center
Whether you call it effervescent, fizzy, or sparkling, carbonated water is making a comeback as a beverage. Aside from quenching thirst, researchers at the University of Illinois at Urbana-Champaign have discovered a new use for these "bubbly" concoctions that will have major impact on the manufacturer of the world's thinnest, flattest, and one most useful materials -- graphene.
As graphene's popularity grows as an advanced "wonder" material, the speed and quality at which it can be manufactured will be paramount. With that in mind,...
Physicists at the University of Bonn have managed to create optical hollows and more complex patterns into which the light of a Bose-Einstein condensate flows. The creation of such highly low-loss structures for light is a prerequisite for complex light circuits, such as for quantum information processing for a new generation of computers. The researchers are now presenting their results in the journal Nature Photonics.
Light particles (photons) occur as tiny, indivisible portions. Many thousands of these light portions can be merged to form a single super-photon if they are...
For the first time, scientists have shown that circular RNA is linked to brain function. When a RNA molecule called Cdr1as was deleted from the genome of mice, the animals had problems filtering out unnecessary information – like patients suffering from neuropsychiatric disorders.
While hundreds of circular RNAs (circRNAs) are abundant in mammalian brains, one big question has remained unanswered: What are they actually good for? In the...
An experimental small satellite has successfully collected and delivered data on a key measurement for predicting changes in Earth's climate.
The Radiometer Assessment using Vertically Aligned Nanotubes (RAVAN) CubeSat was launched into low-Earth orbit on Nov. 11, 2016, in order to test new...
A study led by scientists of the Max Planck Institute for the Structure and Dynamics of Matter (MPSD) at the Center for Free-Electron Laser Science in Hamburg presents evidence of the coexistence of superconductivity and “charge-density-waves” in compounds of the poorly-studied family of bismuthates. This observation opens up new perspectives for a deeper understanding of the phenomenon of high-temperature superconductivity, a topic which is at the core of condensed matter research since more than 30 years. The paper by Nicoletti et al has been published in the PNAS.
Since the beginning of the 20th century, superconductivity had been observed in some metals at temperatures only a few degrees above the absolute zero (minus...
16.08.2017 | Event News
04.08.2017 | Event News
26.07.2017 | Event News
21.08.2017 | Medical Engineering
21.08.2017 | Materials Sciences
21.08.2017 | Life Sciences