Intraaortic balloon pump: incidence and predictors of complications in the Florence registry.

BACKGROUND: The intraaortic balloon pump (IABP) is the most commonly used mechanical circulatory support for patients with acute coronary syndromes and cardiogenic shock. Nevertheless, IABP-related complications are still frequent and associated with a poor prognosis. HYPOTHESIS: To prospectively assess the incidence and predictors of complications in patients treated with IABP. METHODS: A total of 481 patients treated with IABP were prospectively enrolled in our registry (the Florence Registry). At multivariable logistic regression analysis the following variables were independent predictors for complications (when adjusted for age >75 years, eGFR and time length of IABP support): use of inotropes (OR 2.450, P < 0.017), nadir platelet count (1000/µL step; OR 0.990, P < 0.001), admission lactate (OR 1.175, P = 0.003). Nadir platelet count showed a negative correlation with length of time of IABP implantation (r-0.31; P < 0.001). A nadir platelet count cutoff value of less than 120,000 was identified using a receiver operating characteristic (ROC) curve for the development of complications (area under the curve [AUC] 0.70; P < 0.001). RESULTS: Complications were observed in the 13.1%, among whom 33 of 63 showed major bleeding. The incidence of complications was higher in patients aged >75 years (P = 0.015) and in those who had an IABP implanted for more than 24 hours (P = 0.001). Patients with complications showed an in Intensive Cardiac Care Unit (ICCU) mortality higher than patients who did not (44.4% vs 17.2%, P < 0.001). CONCLUSIONS: In consecutive patients treated with IABP support, the degree of hemodynamic impairment and the decrease in platelet count were independent predictors of complications, whose development was associated with higher in-ICCU mortality.

A new post-PCI scoring system for in-hospital mortality in STEMI patients.

OBJECTIVE: To develop a scoring system for predicting in-hospital mortality among ST-elevation myocardial infarction (STEMI) patients submitted to percutaneous intervention (PCI) on intensive cardiac care unit admission by using early and readily available clinical, angiographic and laboratory data. DESIGN: Prospective monocentric observational study in which we used discriminant analysis to develop a final scoring system, with prospective validation. SETTING: Intensive cardiac care unit in Florence, a tertiary center. POPULATION: Five hundred and fifty-eight unselected patients with STEMI (group A) consecutively admitted from 1 January 2004 to 31 December 2006. A control group (group B) comprising 183 STEMI patients admitted from 1 January 2007 to 30 September 2007. MAIN OUTCOMES AND MEASURES: In-hospital death. RESULTS: In group A the discriminant variables were admission Killip class, admission lactic acid, admission ejection fraction, admission troponin I (TnI), admission hemoglobin (Hb), ST-segment reduction post-PCI, systolic blood pressure on admission and chronic renal failure. We elaborated a scoring system, the Florence admission STEMI risk score, which shows an agreement of 95.7% between the observed and the estimated outcome on a statistical basis in the survival and death subgroups. We applied this score to group B (C statistics = 0.986). CONCLUSION: The Florence admission STEMI risk score incorporates anamnestic (chronic renal failure), laboratory (lactic acid, TnI and Hb), procedural and post-procedural data (ST-segment reduction post-PCI, Killip class) as well as data strictly related to infarct size (ejection fraction, TnI). This scoring system is likely to be a simple and practical tool at the bedside for risk evaluation in patients with STEMI submitted to primary PCI.