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Prognosis of patients undergoing cardiac surgery and treated with intra-aortic balloon pump counterpulsation prior to surgery: a long-term follow-up study

Departments of Cardiology and Cardio-Thoracic Surgery, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands

*Corresponding author. Department of Cardiology, Erasmus Medical Center, ‘s-Gravendijkwal 230, Room V-017, NL-3015 CE Rotterdam, The Netherlands. Tel.: +31 10 70 35019; fax: +31 10 70 32890.

E-mail address: c.denuil{at}erasmusmc.nl (C.A. den Uil).

The aim of this study was to evaluate short- and long-term outcome in patients undergoing coronary artery bypass grafting (CABG), who received an intra-aortic balloon pump (IABP) prior to surgery. Between January 1990 and June 2004, all patients (n=154) who received an IABP prior to on-pump CABG in our center were included. Patients received the IABP for vital indications (i.e. either unstable angina refractory to medical therapy or cardiogenic shock; group 1: n=99) or for prophylactic reasons (group 2: n=55). A Cox proportional hazards model was used to identify predictors of long-term all-cause mortality. Compared with the EuroSCORE predictive model, observed 30-day mortality in group 1 (15.2%) was slightly higher than predicted (10.3%). A decrease in 30-day mortality occurred in group 2 (median predicted mortality was 7.2% and observed was 0%). Cumulative 1-, 5-, and 6-year survival was 82.8±3.8%, 70.1±4.9%, and 67.3±5.1% for group 1 vs. 98.2±1.8%, 84.0±5.6% and 84.0±5.6% for group 2 (Log-rank: P=0.02). Logistic EuroSCORE (HR 1.03 [1.01–1.05], P=0.007) was an independent predictor of long-term all-cause mortality.

Key Words: Coronary artery bypass grafting; Intra-aortic balloon pump counterpulsation; Logistic EuroSCORE; Long-term survival; Outcome