Clinical Outcomes of Intra-aortic Balloon Counterpulsation in Patients with St Elevation Myocardial Infarction: Experience at our Tertiary Care Hospital

Background and Objectives: Intra-Aortic Balloon Pump (IABP) is device developed to augment coronary blood flow and improve systemic blood pressure in patients with circulatory failure. This study was undertaken to analyze morbidity and mortality benefit of IABP counterpulsation in patients with Acute Myocardial Infarction (AMI) Methodology: This cross-sectional study done for three years in the Department of Cardiology of a tertiary care centre in North Karnataka from June 2009 to June 2012. Prior to the commencement of the study, ethical clearance was obtained from Human Ethics Committee. A total of 82 consecutive patients presenting with cardiogenic shock were included in the study. The patients satisfying selection criteria were informed in detail about the nature of the study and a written informed consent was obtained. The patients underwent electrocardiography and echocardiography. Based on the findings the indication for IABP was determined. Results: Majority of the patients were males (85.4%) and the commonest age group was 51 to 60 years (40.2%) with the mean age of 57.73 ± 9.41 years. Most common Electrocardiogram (ECG) presentation was Anterior Wall Myocardial Infarction (AWMI) (40.2%). The commonest indication for placement of an IABP was Left Ventricular (LV) dysfunction (47.6%) and mean duration of IABP was 4 ± 1 days. Diagnostic catheterization was performed in 55 (67.1%) patients. Among them, 40 (72.7%) underwent Percutaneous Transluminal Coronary Angioplasty (PTCA) and 15 (27.3%) underwent surgery. Of the 82 patients, major IABP related complications occurred in six (7.3%) patients. The in-hospital mortality rate was 43.9% and 56.1% of the patients improved. Of the 46 patients who improved, majority (78.2%) had undergone revascularization while of the 27 patients who expired, 47.2% did not had revascularization (p=0.015). The outcome in patients who had undergone either PTCA or surgery was significantly favourable resulting in improvement (p<0.050). Conclusion and Interpretation: IABP counterpulsation can be successfully employed for a wide variety of conditions in the AMI setting, providing significant haemodynamic support with rare major complications in a high-risk patient population.