Reducing Muscle Damage After a Heart Attack

Balloon counterpulsation following a heart attack does not reduce heart muscle damage

(RxWiki News) It had been suggested there was a way to reduce the amount of heart muscle damage after a heart attack. New research shows the method that had been believed to help does not cut muscle damage.

Using an intra-aortic balloon pump, a mechanical device that aids with blood flow and oxygen delivery, before angioplasty to widen blocked blood vessels does not successfully reduce heart muscle damage after acute myocardial infarction, a common type of heart attack.

"Ask your doctor about post heart attack recovery."

Dr. Manesh Patel, the principal investigator and a cardiologist at the Duke Clinical Research Institute, said that animal studies had suggested that inserting a balloon pump before opening a blood vessel could reduce the heart's workload, helping to ensure less damage to the heart muscle.

However, no benefit was found when the method was tested in humans during clinical trials.

The multi-center randomized trial enrolled patients with a type of heart attack called acute ST-segment elevation myocardial infarction (STEMI). Patients had not received defibrillation, were within six hours of the onset of chest pain and were expected to receive primary percutaneous coronary intervention (PCI), which includes angioplasty and stent placement.

Of the 337 patients enrolled, 161 were randomized to receive intra-aortic balloon counterpulsation before PCI, and 176 received the standard of care without the balloon pump. Of those,15 patients receiving the standard of care later crossed over and received balloon counterpulsation.

Heart muscle damage was viewed through cardiac magnetic resonance imaging, and was not found to be significantly different between the two groups. At 30 days, major bleeding or transfusion occurred in 3.1 percent of patients who received balloon counterpulsation versus 1.7 percent in patients that did not receive it.

Major vascular complications occurred in 4.3 percent with insertion of the balloon pump, but only 1.1 percent who received the usual standard of care. At six months, 1.9 percent who received the balloon pump had died versus 5.2 percent in the other group.

Dr. Patel said the results suggest that the routine use of balloon counterpulsation is not recommended, but that it is important for doctors to identify patients at risk for rapid deterioration who may benefit from the procedure.

The findings were published in the Journal of the American Medical Association and recently presented at the European Society of Cardiology in Paris.

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Review Date: 
September 6, 2011