所属 医学部 医学科（東京女子医科大学病院） 職種 講師
|発表タイトル||Prognostic Impact of Early Induction of IABP in Patients With Acute Heart Failure|
|会議名||American Heart Association (AHA) Scientific Sessions 2017|
|主催者||American Heart Association|
|発表者・共同発表者||◎YOSHIDA Ayano, JUJO Kentaro, MINAMI Yuichiro, KAMETANI Motoko, MIZOBUCHI Keiko, ISHIDA Issei, KADOWAKI Hiromu, AKASHI Madoka, HARUKI Shintaro, TANAKA Hiroyuki, HAGIWARA Nobuhisa|
|学会抄録||Circulation 136(suppl 1),A18653 2017|
|概要||Background: Intra-aortic balloon pumping (IABP) provides potent supports on hemodynamic status of patients with cardiac shock through decreasing end-diastolic pressure and increasing cardiac output. However, very limited numbers of patients with acute heart failure (AHF) received such benefit of IABP. We aimed to evaluate the impact of the timing of IABP induction on clinical prognosis in AHF patients at very high risk.
Methods: Of 404 consecutive AHF patients who were urgently admitted to our hospital, 59 patients both with left ventricular ejection fraction (LVEF) <35% and systolic blood pressure on admission <100 mmHg were ultimately enrolled in this study. The study population were divided into 3 groups depending on IABP use; the Early-IABP group (induction at <3 days after admission, n=18), Late-IABP group (>3 days, n=16) and Non-IABP group (n=25). In-hospital cardiovascular (CV) mortality as the primary endpoint of this study was retrospectively compared among 3 groups.
Results: Overall in-hospital CV mortality was 23.7% in the study population. This high-risk population was typically mid-age (62 years old), 63% male, and 78% with chronic kidney disease, and its average LVEF was 24.7%. Clinical profiles on admission were comparable among 3 subgroups, except prehospital administration of loop diuretics. During hospital stay, intravenous inotropes were significantly more frequently administered in the Late-IABP group than other 2 groups. In-hospital mortality in the Early-IABP group was 5.6%, which was significantly lower than that in the Late-IABP group (31.3%, p=0.049) and in Non-IABP group (32.0%, p=0.036, Figure). Additionally, hospital stay of patients who discharged alive in the Early-IABP group was significantly shorter than other 2 groups (21 [12-49] vs. 68 [26-93] vs. 40 [24-64] days, p=0.024).
Conclusions: Early induction of IABP is one of the therapeutic options for improvement of in-hospital prognosis in AHF patients at very high risk.