Abstract
Background
This prospective observational study aimed to identify the predictors of intra-aortic balloon pump (IABP) insertion in patients undergoing elective coronary artery bypass grafting (CABG) and to formulate a scoring system to categorize the patients to low-, moderate-, and high-risk groups.
Patients and methods
Of the consecutive patients, 105 were enrolled for elective CABG. Pre-operative evaluation consisted of history, examination, electrocardiogram, echocardiogram, and coronary angiogram. IABP was inserted either intra- or post-operatively depending on indications laid down in the study. Various pre-, intra-, and post-operative data were analyzed and the patients were followed up till their discharge from the hospital.
Results
The mean age of the study population was 59.1 ± 8.9 years. The risk factors for IABP requirement were NYHA class III/IV angina (p = 0.019, CI 1.18–11.89), family history of hypertension (p = 0.025, CI 1.09–18.12), pre-operative serum creatine kinase myocardial isozyme ≥30 U/L (p = 0.008, CI 1.37–10.43), cardiomegaly (p = 0.002) and pleural effusion (0.014), abnormal rhythm and ST-T changes (p = 0.011), left ventricular ejection fraction <50% (p = 0.001, CI 2.50–17.60), non-usage of arterial grafts (p = 0.002, CI 1.70–13.91), transfusion requirement ≥1500 mL (p = 0.003, CI 1.51–9.80), and intra-operative defibrillation (p = 0.014). Six deaths were reported in the study (5.7%), and the mortality was significantly higher in the IABP group (n = 5, 19.2%) as compared to the non-IABP group (n = 1, 1.26%). A scoring system was formulated based on four risk factors identified by the multivariate logistic regression analysis.
Conclusions
We conclude that patients with higher risk scores (derived from risk factors identified in the study) are more likely to require IABP which may be instituted at an early phase to avoid late cardiac decompensation.
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All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was duly approved by the Institute Ethics Committee.
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Written informed consent was taken from all the study participants before enrolling them for the study.
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The authors declare that they have no conflict of interest.
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We all the authors declare that we did not receive any funding from any source for conducting this study.
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Sahu, M.K., Das, A., Hote, M.P. et al. Predictors of intra-aortic balloon pump insertion in different spectrum of patients undergoing elective coronary artery bypass grafting. Indian J Thorac Cardiovasc Surg 33, 296–302 (2017). https://doi.org/10.1007/s12055-017-0577-z
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DOI: https://doi.org/10.1007/s12055-017-0577-z