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Research Letter | Less Is More

Use of Intra-aortic Balloon Pump in a Japanese Multicenter Percutaneous Coronary Intervention Registry

Taku Inohara, MD, PhD1; Hiroaki Miyata, PhD2; Ikuko Ueda, PhD1; Yuichiro Maekawa, MD, PhD1; Keiichi Fukuda, MD, PhD1; Shun Kohsaka, MD, PhD1
[+] Author Affiliations
1Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
2Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
JAMA Intern Med. 2015;175(12):1980-1982. doi:10.1001/jamainternmed.2015.5119.
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This study investigates the prognostic effect of intra-aortic balloon pump use in Japanese patients undergoing percutaneous coronary intervention for nonacute and acute indications.

We read with interest the recent meta-analysis by Ahmad et al,1 demonstrating a negative association between intra-aortic balloon pump (IABP) therapy and mortality among patients experiencing acute myocardial infarction. We agree that efforts are needed to clarify the role of IABP therapy and to examine its effect on care in other regions and countries. In Japan, IABP therapy is frequently used in patients with guideline-based indications and in patients with less established indications, and the judicious use of invasive procedures has been highlighted.2,3 Our objective herein was to investigate the prognostic effect of IABP use in patients undergoing percutaneous coronary intervention (PCI) for nonacute and acute indications registered in a contemporary multicenter Japanese PCI registry (Japan Cardiovascular Database-Keio Interhospital Cardiovascular Studies4).

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Unadjusted and Adjusted Effects of Intra-aortic Balloon Pump (IABP) Use on In-Hospital Mortality in Various Situations

A and B, Intra-aortic balloon pump use was adversely associated with patient outcome, regardless of situation, in crude (A) and multivariable (B) analyses. In the logistic regression model, adjustments were made using all variables exhibiting a bivariate association with the use of IABP with P < .001 in the Table, which included all variables except the following: diabetes mellitus, previous coronary artery bypass graft, chronic lung disease, stable angina or silent ischemia, and 1-vessel disease. C, For evaluating the baseline inequality index, we redefined a list of the following baseline characteristics that are recognized markers of mortality risk: age, cardiogenic shock, prior heart failure, peripheral vascular disease, chronic lung disease, renal dysfunction, NYHA functional classification of at least 3 at the time of percutaneous coronary intervention, and clinical presentation (STEMI or NSTEMI). LMT indicates left main trunk; NSTEMI, non–ST-segment elevation myocardial infarction; NYHA, New York Heart Association; and STEMI, ST-segment elevation myocardial infarction.

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