Myocardial infarction: intraaortic balloon counterpulsation had no clear effect.

Clinical bottom line (level 2b-)

  1. Patients with early myocardial infarction and acute heart failure who were given intraaortic balloon counterpulsation, had no clear difference in mortality than those not given this treatment.
O'Rourke et al: American Journal of Cardiology 1981; 47: 815-820
Expires March 2003

The study

Unblinded concealed randomised trial with intention-to-treat
Setting: 2 hospitals, 1 in Australia and the other in New Zealand

30 patients (aged range 42 to 69 years; mean 57, 80% male) acute transmural infarction with either evolving Q waves or S-T segment elevation greater than 2 mm in at least two leads, with evidence of cardiac failure by clinical and radiologic criteria

Excluded if
  • onset of symptoms not <12 hours before randomisation
  • presence of preexisting cardiac failure or other life-threatening disease
  • >70 years old
  • contraindications to counterpulsation
  • failure to notify investigators within the appointed time (<12 hours after onset of symptoms)
  • unavailability of surgeons or balloon pump within the appointed time
  • reluctance of the attending physician to have a patient enter the trial


    • Control Group: (n = 16, 16 analysed): no intraaortic balloon counterpulsation
    Experimental Group: (n = 14, 14 analysed): Intraaortic balloon counterpulsation. The balloon was inserted through a side graft into the femoral artery. Counterpulsation was continued electively for 3-11 days and the balloon catheter was removed when the patient's condition had been stable without evidence of heart failure for 48 hours.
    All patients had systemic and most had pulmonary arterial cannulation. All patients received oxygen and furosemide as required, and heparin intravenously. Lidocaine, dopamine and norepinephrine were also administered.
    100% followed for ? range 1 to 36 months
    Outcome notes:
    • total mortality : death in hospital and late death

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    total mortality unknown 10
    (62.5%)    		 8
    (57.1%)    		 9%
    (-65% to 49%)    		 5.36%
    (-29.8% to 40.5%)    		 19
    (NNT = 2 to infinity;
    NNH = 3 to infinity)

    Comments

    1. The trial is far too small to show any difference in mortality between the two groups.

    Citation

    1. O'Rourke MF, Norris RM, Campbell TJ, et al: Randomized controlled trial of intraaortic balloon counterpulsation in early myocardial infarction with acute heart failure. American Journal of Cardiology 1981; 47: 815-820
    Contributor: Clare Wotton and Bob Phillips, October 1999
    Reviewer:

    Clinical Question.
    Patient myocardial infarction with acute heart failure
    Intervention or Exposure intraaortic balloon counterpulsation
    Comparison standard care
    Outcome survival