Donnerstag, 6. August 2009 Leitlinien - <strong>IABP</strong> und STEMI • Kardiogener Schock, nicht unmittelbar ansprechend auf Volumen und Pharmakotherapie (AHA : I, B ESC: I, B) • Low Output (AHA: I, B ESC IIa, B) • Evidenz?
<strong>IABP</strong> bei high-risk STEMI ized clinical trials of <strong>IABP</strong> therapy in STEMI. All meta-analyses show effect estimates for the individual trials, and for the overall analysis. The size of each square is proportional to the weight of the individual trial. (A) lity. (B) The mean differences in left ventricular ejection fraction (LVEF). (C and D) The risk differences in P, intra-aortic balloon counterpulsation; PCI, percutaneous coronary intervention. difference for three trials that . Overall, <strong>IABP</strong> support in the d with a change in LVEF at 95% CI, 22.2 to 2.0%; P ¼ absolute numbers of stroke , together with the respective ial. Overall, the use of <strong>IABP</strong> stroke rate of 2% (95% CI, leeding rate of 6% (95% CI, ype of reperfusion therapy the comprehensive analyses. neity across the seven trials. ewed distributions, suggesting . Donnerstag, 6. August 2009 K.D. Sjauw et al. 464 Meta-analysis of cohort studies of intra-aortic balloon pump therapy in STEMI patients with cardiogenic shock Nine cohort studies of <strong>IABP</strong> therapy in STEMI patients with cardiogenic shock included a total of 10 529 patients. 20 – 29 Table 4 shows the study characteristics. Patients in the <strong>IABP</strong> group were younger (66 vs. 73 years) and more often male (63 vs. 53%). Figure 3A shows the absolute numbers of deaths in each treatment group, with the absolute risk difference for each cohort study. The thrombolysis studies showed adjunctive <strong>IABP</strong> therapy to be associated with an absolute decrease in 30 day mortality of 18% (95% CI, 16–20%; P , 0.0001). Contrariwise, the primary PCI studies showed <strong>IABP</strong> therapy to be associated with an absolute increase 464 Figure 2 Meta-analysis of randomized clinical trials of <strong>IABP</strong> therapy in STEMI. All meta-analyses show effect estimates for the individual trials, for each type of reperfusion therapy and for the overall analysis. The size of each square is proportional to the weight of the individual trial. (A) The risk differences in 30 day mortality. (B) The mean differences in left ventricular ejection fraction (LVEF). (C and D) The risk differences in stroke and major bleeding rate. <strong>IABP</strong>, intra-aortic balloon counterpulsation; PCI, percutaneous coronary intervention. each treatment group, with the mean difference for three trials that reported on left ventricular function. Overall, <strong>IABP</strong> support in the setting of STEMI was not associated with a change in LVEF at follow up (mean difference 20.1%; 95% CI, 22.2 to 2.0%; P ¼ 0.93). Figure 2C and D shows the absolute numbers of stroke and bleeding in each treatment group, together with the respective absolute risk differences for each trial. Overall, the use of <strong>IABP</strong> was associated with an increased stroke rate of 2% (95% CI, 0–4%; P ¼ 0.03) and an increased bleeding rate of 6% (95% CI, 1–11%; P ¼ 0.02). Analyses by type of reperfusion therapy yielded similar results to those of the comprehensive analyses. There was no evidence of heterogeneity across the seven trials. None of the funnel plots showed skewed distributions, suggesting that no publication bias was involved. each treatment group, with the mean difference for three trials that reported on left ventricular function. Overall, <strong>IABP</strong> support in the setting of STEMI was not associated with a change in LVEF at follow up (mean difference 20.1%; 95% CI, 22.2 to 2.0%; P ¼ 0.93). Figure 2C and D shows the absolute numbers of stroke and bleeding in each treatment group, together with the respective absolute risk differences for each trial. Overall, the use of <strong>IABP</strong> was associated with an increased stroke rate of 2% (95% CI, 0–4%; P ¼ 0.03) and an increased bleeding rate of 6% (95% CI, 1–11%; P ¼ 0.02). Analyses by type of reperfusion therapy yielded similar results to those of the comprehensive analyses. Meta-analysis of cohort studies of intra-aortic balloon pump therapy in STEMI patients with cardiogenic shock Nine cohort studies of <strong>IABP</strong> therapy in STEMI patients with cardiogenic shock included a total of 10 529 patients. 20 – 29 Table 4 shows the study characteristics. Patients in the <strong>IABP</strong> group were younger (66 vs. 73 years) and more often male (63 vs. 53%). Figure 3A shows the absolute numbers of deaths in each treatment group, with the absolute risk difference for each cohort study. The thrombolysis studies showed adjunctive <strong>IABP</strong> therapy to be associated with an absolute decrease in 30 day mortality of 18% (95% CI, 16–20%; P , 0.0001). Contrariwise, the primary PCI studies showed <strong>IABP</strong> therapy to be associated with an absolute increase K.D. Sjauw et al. Figure 2 Meta-analysis of randomized clinical trials of <strong>IABP</strong> therapy in STEMI. All meta-analyses show effect estimates for the individual trials, for each type of reperfusion therapy and for the overall analysis. The size of each square is proportional to the weight of the individual trial. (A) The risk differences in 30 day mortality. (B) The mean differences in left ventricular ejection fraction (LVEF). (C and D) The risk differences in stroke and major bleeding rate. <strong>IABP</strong>, intra-aortic balloon counterpulsation; PCI, percutaneous coronary intervention. Meta-analysis of cohort studies of intra-aortic balloon pump therapy in STEMI patients with cardiogenic shock Sjauw, EHJ 2009 Nine cohort studies of <strong>IABP</strong> therapy in STEMI patients with cardiogenic shock included a total of 10 529 patients. 20 – 29 Table 4 shows the study characteristics. Patients in the <strong>IABP</strong> group were younger (66 vs. 73 years) and more often male (63 vs. 53%). Figure 3A shows the absolute numbers of deaths in each treatment group, with the absolute risk difference for each cohort study. The thrombolysis studies showed adjunctive <strong>IABP</strong> therapy to be associated
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