{"id":1542,"date":"2013-12-29T15:36:43","date_gmt":"2013-12-29T14:36:43","guid":{"rendered":"https:\/\/blogs.bmj.com\/heart-journalscan\/?p=1542"},"modified":"2015-11-12T16:40:33","modified_gmt":"2015-11-12T15:40:33","slug":"no-clinical-outcome-benefit-from-iabp-support","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/heart\/2013\/12\/29\/no-clinical-outcome-benefit-from-iabp-support\/","title":{"rendered":"No clinical outcome benefit from IABP support"},"content":{"rendered":"<p style=\"text-align: justify\">The IABP-SHOCK II trial is the largest randomized trial of intra-aortic balloon pump (IABP) counterpulation support in cardiogenic shock.\u00a0 At 30-days follow-up, this trial demonstrated no mortality reduction.\u00a0 The current paper reports the longer term outcomes from this trial, given that the benefits of IABP may not be evident in early follow-up.<!--more--><\/p>\n<p style=\"text-align: justify\">The IABP-SHOCK II trial was a randomized, open-label, multi-center trial of 600 with cardiogenic shock complicating acute MI and undergoing early revascularization.\u00a0 At one-year, IABP did not mortality (relative risk [RR] 1.01; 95% confidence interval [CI] 0.86-1.18; p=0.91), reinfarction (RR 2.60; 95% CI 0.95-7.10; p=0.05) recurrent revascularization (RR 0.91, 95% CI 0.58-1.41; p=0.77) or stroke (RR 1.50; 95% CI 0.25-8.84; p=1.00).\u00a0 Additionally, IABP use did not result in significant differences in quality-of-life measures.\u00a0 Negative trial results often raise questions about power.\u00a0 However, as the authors note, the absolute risk difference of 0.4% for mortality between the two groups is very small, there were no indications of benefit in any other outcome variable, and there was a trend toward higher risk of reinfarction in the IABP group.\u00a0 \u00a0\u00a0These together make it unlikely there was a type II error in this study.<\/p>\n<p style=\"text-align: justify\"><b>Conclusion:<\/b><\/p>\n<p style=\"text-align: justify\">This large trial of IABP counterpulsation for patients with cardiogenic shock complicating acute MI showed no reduction in long-term mortality and raise questions about the clinical utility of IABPs.\u00a0 Similar trials of newer technologies for left ventricular support are needed to understand if larger increases in cardiac output support may overcome the lack of benefit seen with IABP support.<\/p>\n<ul>\n<li style=\"text-align: justify\">\u00a0Thiele H, Zeymer U, Neumann F-J, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. The Lancet. 2013;382(9905):1638\u20131645.<\/li>\n<\/ul>\n<p><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The IABP-SHOCK II trial is the largest randomized trial of intra-aortic balloon pump (IABP) counterpulation support in cardiogenic shock.\u00a0 At 30-days follow-up, this trial demonstrated no mortality reduction.\u00a0 The current paper reports the longer term outcomes from this trial, given that the benefits of IABP may not be evident in early follow-up. [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/heart\/2013\/12\/29\/no-clinical-outcome-benefit-from-iabp-support\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":47,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[280],"tags":[743,2915,2914],"class_list":["post-1542","post","type-post","status-publish","format-standard","hentry","category-interventional-cardiology","tag-cardiogenic-shock","tag-counterpulsation","tag-iabp"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>No clinical outcome benefit from IABP support - Heart<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/heart\/2013\/12\/29\/no-clinical-outcome-benefit-from-iabp-support\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"No clinical outcome benefit from IABP support - Heart\" \/>\n<meta property=\"og:description\" content=\"The IABP-SHOCK II trial is the largest randomized trial of intra-aortic balloon pump (IABP) counterpulation support in cardiogenic shock.\u00a0 At 30-days follow-up, this trial demonstrated no mortality reduction.\u00a0 The current paper reports the longer term outcomes from this trial, given that the benefits of IABP may not be evident in early follow-up. 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