Effect of gender on efficacy of preoperative intra-aortic balloon pump in high risk patients undergoing surgical coronary revascularisation.

Abstract

BACKGROUND: There is no strong evidence supporting the use of preoperative intra-aortic balloon pump (IABP) in high-risk patients undergoing coronary artery bypass grafting (CABG). This issue has only been investigated in small studies which analysed the general population of patients, without focusing on specific subgroups, including gender. AIM: We sought to determine if there is any benefit from preoperative IABP in high-risk patients undergoing CABG with the analysis of its determinants including gender. METHODS: We randomly assigned 502 high-risk patients (351 men, 151 women) to the group receiving preoperative IABP support or to the control group with no preoperative IABP. Primary end-point was a major adverse cardiac or cerebrovascular event (MACCE), defined as death from any cause, myocardial infarction, cerebrovascular accident or repeat revascularisation within 30 days post-surgery. RESULTS: A significant reduction of MACCE rate in patients with the preoperative IABP counterpulsation in comparison to controls was noticed in the total population of high risk patients (p=0.001) and in the female subgroup (p=0.005). After adjustment for baseline characteristics, the hazard ratio for MACCE was 0.7 (p=0.005) in the total population; 0.6 (p=0.01) for females and 0.8 (p=0.1) for males. CONCLUSIONS: There is a beneficial effect of preoperative IABP use in high-risk patients undergoing CABG, particularly in women and patients with co-morbidities (diabetes, obesity, and peripheral vascular disease).