Copyright © 2003 by the European Society of Cardiology.
Clinical research
Intra-aortic balloon counterpulsation in US and non-US centres: results of the Benchmark® Registry
a From the Division of Cardiology, MCP Hahnemann University School of Medicine Philadelphia, PA, USA
b Hôpital de la Tour, Geneva, Switzerland
c University Hospital, Geneva, Switzerland
d Datascope Corp., Fairfield, NJ, USA
e Tulane University Medical Center, New Orleans, LA, USA
f M. F. Miller Statistical Services, Langhorne, PA, USA
g University of North Carolina Medical Center, Chapel Hill, NC, USA
h SUNY Health Center, Brooklyn, NY, USA
i The Cardiovascular Research Foundation, New York City, NY, USA
j The Texas Heart Institute, Houston, TX, USA
* Correspondence to: Marc Cohen, MD, Director, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ 07112, USA. Tel: +1 973 926-7852; Fax: +1 973 282-0839
E-mail address: marcohen{at}sbhcs.com
Received 21 October 2002; revised 6 June 2003; accepted 2 July 2003
Abstract
Aims To examine differences in patient characteristics and outcomes in 19 636 patients enrolled in the USA and 3027 patients enrolled in other countries undergoing intra-aortic balloon pump (IABP) counterpulsation.
Methods and results Indications for IABP use; a larger percentage of US patients were identified as ‘early support and stabilization for angiography or angioplasty’ (21.1% US vs 11.8% non-US), and ‘pre-operative support for high-risk CABG’ (15.9% vs 6.6%). A smaller percentage of US patients vs non-US patients were identified as ‘weaning from cardiopulmonary bypass’ (14.3% vs 28.2%), and ‘refractory ventricular failure’ (6.2% vs 9.8%). One out of five patients in both groups was listed as ‘cardiogenic shock’ (18.9% US vs 20.2% non-US). All cause, risk-adjusted, in-hospital mortality (20.1% vs 28.7%; P<0.001), and mortality with IABP in place (10.8% vs 18.0%; P<0.001) were lower at US vs non-US sites. In both US and non-US institutions, IABP associated complication rates, such as IABP-related mortality (0.05% vs 0.07%), major limb ischaemia (0.9% vs 0.8%), and severe bleeding (0.9% vs 0.8%), were low.
Conclusions IABP counterpulsation is deployed at an earlier clinical stage in US patients. Mortality rates are higher for non-US patients, particularly for patients with non-surgery cardiac interventions, even after adjusting for risk factors. Complication rates were low. Physicians should therefore not be reluctant to use IABP in high-risk patients undergoing cardiac procedures.
Key Words: Heart assist device • Peripheral vascular disease • Balloon • Population
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