No Benefit from Preventive Intra-aortic Balloon Pump during Angioplasty

Intra-aortic balloon pump insertion prior to high-risk PCI does not reduce the incidence of adverse cardiac and cardiovascular events in patients with severe left ventricular dysfunction and extensive coronary disease.

According to research sponsored by the UK’s National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre at Guy's and St Thomas' Foundation Trust and King's College London, patients with coronary artery disease who undergo angioplasty “do not benefit from having their circulation artificially supported with a balloon pump as a preventative measure during angioplasty.”

A news release from King’s College London reports on results from the Balloon pump-assisted Coronary Intervention Study (BCIS-1), which enrolled more than 300 patients with “severe left ventricular dysfunction and extensive coronary artery disease” who underwent angioplasty with or without prior insertion of a balloon pump.

According to the news release, researchers reported that there was “no difference in the proportion of patients who suffered major cardiovascular complications (comprising death, acute myocardial infarction, cerebrovascular events or further revascularisation, at hospital discharge capped at 28 days) in the group who received a balloon pump beforehand (15.2%), compared to those who did not (16%).”

The researchers reported that roughly one in eight patients who did not receive a balloon pump prior to angioplasty needed an emergency balloon pump insertion during the procedure, which the researchers said underscores the importance of “having a balloon pump on standby when undertaking such cases.”

Dr. Simon Redwood, Reader in Interventional Cardiology at King's College London and Honorary Consultant Cardiologist at Guy's and St Thomas' said that although interventional cardiologists had for years advocated the use of a balloon pump during angioplasty, until this study there wasn’t sufficient evidence of the procedure’s clinical and safety benefits to make it a requirement. It was hoped that this study would rectify that.

However, Redwood said that rather than demonstrating the benefits of balloon pump support during angioplasty, this study revealed that “inserting a balloon pump into the aorta as a preventative measure has little or no impact on the incidence of major complications and death in high risk cardiac patients, although there is still an important role for using a pump in an emergency.”

These results are especially important, according to Redwood, because “angioplasty is now the most common interventional treatment for treating coronary artery disease.” The study raises “important questions about current clinical practice and whether it is necessary to use a balloon pump routinely during the procedure. The findings may reflect the fact that angioplasty has become a less risky procedure over time as cardiologists have increased their skills,” said Redwood.

The study “Elective Intra-aortic Balloon Counterpulsation During High-Risk Percutaneous Coronary Intervention” was published in the August 25, 2010, issue of JAMA. The authors reported that elective intra-aortic balloon pump (IABP) insertion prior to high-risk percutaneous coronary intervention (PCI) did not reduce the incidence of major adverse cardiac and cardiovascular events in patients with severe left ventricular dysfunction and extensive coronary disease.