Thanks Ash,

That 'pooled randomized data do not support IABP in patients with high-risk STEMI' was known way back in 2009. http://eurheartj.oxfordjournals.org/content/30/4/459.abstract?ijkey=88e7e98622d1470ce9d04bf9bc56f9baf520ee7e&keytype2=tf_ipsecsha

The 2009 systematic review had challenged the guideline even at that time. Recently an Aug 2012 ESC guideline mentioned the systematic review and yet seemed to play safe when it came to actually providing any real guideline on IABP: http://eurheartj.oxfordjournals.org/content/early/2012/08/23/eurheartj.ehs215.full#sec-68

best, rakesh

On Mon, Aug 27, 2012 at 12:09 PM, Ash Paul <[log in to unmask]> wrote:

 

 
Dear colleagues,
Here is yet another instance of the Theory of Plausibility in Interventional Cardiology Biting the Dust!.
This article is from the CardioBrief Blog. The original article is in the NEJM. There is also an accompanying Editorial in the NEJM as well.
 
 
 
 

ESC: Trial Finds No Benefit For Intraaortic Balloon Counterpulsation In Cardiogenic Shock      

by Larry Husten •
Despite a lack of evidence, circulatory support with intraaortic balloon counterpulation (IABP) has a class 1 recommendation in the guidelines and is often used in patients in cardiogenic shock following myocardial infarction for whom early revascularization is planned. That situation may change soon, as no benefit was found for the use of IABP in the first large trial of the strategy.
The IABP-SHOCK II (Intraaortic Balloon Pup in Cardiogenic Shock II) was presented at the ESC and published simultaneously in the New England Journal of Medicine. Trial investigators, led by Holger Thiele, randomized 600 acute MI patients in cardiogenic shock to either IABP or no IABP. At 30 days there were no significant differences in mortality, the primary endpoint of the study:
  • Mortality: 39.7% in the IABP group versus 41.3% in the control group (relative risk with IABP 0.96, CI 0.79-1.17, p=0.69)
There were no significant differences between the groups in secondary endpoints, process-of-care outcomes, or safety endpoints, including stroke and bleeding.
In an accompanying editorial, Christopher O’Connor and Joseph Rogers write that the trial “could have affirmed contemporary clinical practice and guidelines” but, “instead, it revealed surprising results.”
“Members of guidelines committees and clinicians should take note of another example of a recommendation that is based on insufficient data,” they wrote.