Use of aortic counterpulsation to improve sustained coronary artery patency during acute myocardial infarction

Results of a randomized trial

E. Magnus Ohman, Barry S. George, Christopher J. White, Morton J. Kern, Paul A. Gurbel, Robert J. Freedman, Conor Lundergan, Joseph R. Hartmann, J. David Talley, Martin J. Frey, George Taylor, Jeffrey D. Leimberger, Paul M. Owens, Kerry L. Lee, Richard S. Stack, Robert M. Califf

Research output: Contribution to journalArticle

220 Citations (Scopus)

Abstract

Background: Aortic counterpulsation has been observed to reduce the rate of reocclusion of the infarct-related artery after patency has been restored during acute myocardial infarction in observational studies. To evaluate the benefit-to-risk ratio of aortic counterpulsation during the early phase of myocardial infarction, a multicenter randomized clinical trial was performed. Methods and Results: Patients who had patency restored during acute cardiac catheterization within the first 24 hours of onset of myocardial infarction were randomly assigned to aortic counterpulsation for 48 hours versus standard care. Intravenous heparin was used similarly in both groups and was continued for a median (25th, 75th percentile) of 5 (2,7) days. A total of 182 patients were enrolled; 96 were assigned to aortic counterpulsation and 86 to standard care. Repeat cardiac catheterization was performed at a median of 5 (4,6) days after randomization in 89% of patients assigned to aortic counterpulsation and in 90% of control patients. Patients randomized to aortic counterpulsation had similar rates of severe bleeding complications (2% versus 1%), number of units of blood transfused (mean, 1.3±2.6 versus 0.9±1.8 units), and vascular repair or thrombectomy (5% versus 2%) compared with patients treated in a conventional manner. Patients randomized to aortic counterpulsation had significantly less reocclusion of the infarct-related artery during follow-up compared with control patients (8% versus 21%, P<.03). In addition, there was a significantly lower event rate in patients assigned to aortic counterpulsation in terms of a composite clinical end point (death, stroke, reinfarction, need for emergency revascularization with angioplasty or bypass surgery, or recurrent ischemia): 13% versus 24%, P<.04. Conclusions: This randomized trial showed that careful use of prophylactic aortic counterpulsation can prevent reocclusion of the infarct-related artery and improve overall clinical outcome in patients undergoing acute cardiac catheterization during myocardial infarction.

Original languageEnglish
Pages (from-to)792-799
Number of pages8
JournalCirculation
Volume90
Issue number2
StatePublished - Aug 1 1994
Externally publishedYes

Fingerprint

Counterpulsation
Coronary Vessels
Myocardial Infarction
Cardiac Catheterization
Arteries
Thrombectomy
Random Allocation
Angioplasty
Observational Studies
Blood Vessels
Heparin
Emergencies
Ischemia
Randomized Controlled Trials
Stroke
Odds Ratio
Hemorrhage

Keywords

  • angioplasty
  • aorta
  • aortic counterpulsation
  • myocardial infarction

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Ohman, E. M., George, B. S., White, C. J., Kern, M. J., Gurbel, P. A., Freedman, R. J., ... Califf, R. M. (1994). Use of aortic counterpulsation to improve sustained coronary artery patency during acute myocardial infarction: Results of a randomized trial. Circulation, 90(2), 792-799.

Use of aortic counterpulsation to improve sustained coronary artery patency during acute myocardial infarction : Results of a randomized trial. / Ohman, E. Magnus; George, Barry S.; White, Christopher J.; Kern, Morton J.; Gurbel, Paul A.; Freedman, Robert J.; Lundergan, Conor; Hartmann, Joseph R.; Talley, J. David; Frey, Martin J.; Taylor, George; Leimberger, Jeffrey D.; Owens, Paul M.; Lee, Kerry L.; Stack, Richard S.; Califf, Robert M.

In: Circulation, Vol. 90, No. 2, 01.08.1994, p. 792-799.

Research output: Contribution to journalArticle

Ohman, EM, George, BS, White, CJ, Kern, MJ, Gurbel, PA, Freedman, RJ, Lundergan, C, Hartmann, JR, Talley, JD, Frey, MJ, Taylor, G, Leimberger, JD, Owens, PM, Lee, KL, Stack, RS & Califf, RM 1994, 'Use of aortic counterpulsation to improve sustained coronary artery patency during acute myocardial infarction: Results of a randomized trial', Circulation, vol. 90, no. 2, pp. 792-799.
Ohman, E. Magnus ; George, Barry S. ; White, Christopher J. ; Kern, Morton J. ; Gurbel, Paul A. ; Freedman, Robert J. ; Lundergan, Conor ; Hartmann, Joseph R. ; Talley, J. David ; Frey, Martin J. ; Taylor, George ; Leimberger, Jeffrey D. ; Owens, Paul M. ; Lee, Kerry L. ; Stack, Richard S. ; Califf, Robert M. / Use of aortic counterpulsation to improve sustained coronary artery patency during acute myocardial infarction : Results of a randomized trial. In: Circulation. 1994 ; Vol. 90, No. 2. pp. 792-799.
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abstract = "Background: Aortic counterpulsation has been observed to reduce the rate of reocclusion of the infarct-related artery after patency has been restored during acute myocardial infarction in observational studies. To evaluate the benefit-to-risk ratio of aortic counterpulsation during the early phase of myocardial infarction, a multicenter randomized clinical trial was performed. Methods and Results: Patients who had patency restored during acute cardiac catheterization within the first 24 hours of onset of myocardial infarction were randomly assigned to aortic counterpulsation for 48 hours versus standard care. Intravenous heparin was used similarly in both groups and was continued for a median (25th, 75th percentile) of 5 (2,7) days. A total of 182 patients were enrolled; 96 were assigned to aortic counterpulsation and 86 to standard care. Repeat cardiac catheterization was performed at a median of 5 (4,6) days after randomization in 89{\%} of patients assigned to aortic counterpulsation and in 90{\%} of control patients. Patients randomized to aortic counterpulsation had similar rates of severe bleeding complications (2{\%} versus 1{\%}), number of units of blood transfused (mean, 1.3±2.6 versus 0.9±1.8 units), and vascular repair or thrombectomy (5{\%} versus 2{\%}) compared with patients treated in a conventional manner. Patients randomized to aortic counterpulsation had significantly less reocclusion of the infarct-related artery during follow-up compared with control patients (8{\%} versus 21{\%}, P<.03). In addition, there was a significantly lower event rate in patients assigned to aortic counterpulsation in terms of a composite clinical end point (death, stroke, reinfarction, need for emergency revascularization with angioplasty or bypass surgery, or recurrent ischemia): 13{\%} versus 24{\%}, P<.04. Conclusions: This randomized trial showed that careful use of prophylactic aortic counterpulsation can prevent reocclusion of the infarct-related artery and improve overall clinical outcome in patients undergoing acute cardiac catheterization during myocardial infarction.",
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T2 - Results of a randomized trial

AU - Ohman, E. Magnus

AU - George, Barry S.

AU - White, Christopher J.

AU - Kern, Morton J.

AU - Gurbel, Paul A.

AU - Freedman, Robert J.

AU - Lundergan, Conor

AU - Hartmann, Joseph R.

AU - Talley, J. David

AU - Frey, Martin J.

AU - Taylor, George

AU - Leimberger, Jeffrey D.

AU - Owens, Paul M.

AU - Lee, Kerry L.

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AB - Background: Aortic counterpulsation has been observed to reduce the rate of reocclusion of the infarct-related artery after patency has been restored during acute myocardial infarction in observational studies. To evaluate the benefit-to-risk ratio of aortic counterpulsation during the early phase of myocardial infarction, a multicenter randomized clinical trial was performed. Methods and Results: Patients who had patency restored during acute cardiac catheterization within the first 24 hours of onset of myocardial infarction were randomly assigned to aortic counterpulsation for 48 hours versus standard care. Intravenous heparin was used similarly in both groups and was continued for a median (25th, 75th percentile) of 5 (2,7) days. A total of 182 patients were enrolled; 96 were assigned to aortic counterpulsation and 86 to standard care. Repeat cardiac catheterization was performed at a median of 5 (4,6) days after randomization in 89% of patients assigned to aortic counterpulsation and in 90% of control patients. Patients randomized to aortic counterpulsation had similar rates of severe bleeding complications (2% versus 1%), number of units of blood transfused (mean, 1.3±2.6 versus 0.9±1.8 units), and vascular repair or thrombectomy (5% versus 2%) compared with patients treated in a conventional manner. Patients randomized to aortic counterpulsation had significantly less reocclusion of the infarct-related artery during follow-up compared with control patients (8% versus 21%, P<.03). In addition, there was a significantly lower event rate in patients assigned to aortic counterpulsation in terms of a composite clinical end point (death, stroke, reinfarction, need for emergency revascularization with angioplasty or bypass surgery, or recurrent ischemia): 13% versus 24%, P<.04. Conclusions: This randomized trial showed that careful use of prophylactic aortic counterpulsation can prevent reocclusion of the infarct-related artery and improve overall clinical outcome in patients undergoing acute cardiac catheterization during myocardial infarction.

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