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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThe Intra-Aortic Balloon Pump in Cardiogenic Shock II [IABP-SHOCK II; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00491036\u0026amp;atom=%2Fspmdc%2F12%2F13%2F16.atom\u0022\u003ENCT00491036\u003C\/a\u003E] trial failed to demonstrate a significant reduction in 30-day mortality with use of an IABP compared with best available medical therapy alone in patients with acute myocardial infarction complicated by cardiogenic shock.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EMyocardial Infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EInterventional Techniques \u0026amp; Devices\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EThe Intra-Aortic Balloon Pump (IABP) in Cardiogenic Shock II [IABP-SHOCK II; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00491036\u0026amp;atom=%2Fspmdc%2F12%2F13%2F16.atom\u0022\u003ENCT00491036\u003C\/a\u003E] trial, presented by Holger Thiele, MD, University of Leipzig Heart Center, Leipzig, Germany, failed to demonstrate a significant reduction in 30-day mortality with use of an IABP compared with best available medical therapy (BAT) alone in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EIABPs have been used for almost 5 decades in the treatment of cardiogenic shock [Thiele H et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2010]. Although considered a Class I recommendation in patients with AMI complicated by cardiogenic shock in both US and European guidelines [Van de Werf EM et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2008; Wijns F et al. \u003Cem\u003EEur Heart J\u003C\/em\u003E 2010; Antman W et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2004], there is no evidence for a mortality benefit. IABP-SHOCK II was an investigator-initiated, randomized, prospective, open-label, multicenter trial, designed to compare IABP with BAT in patients presenting with an AMI complicated by cardiogenic shock and for whom early revascularization (using either percutaneous coronary intervention [PCI] or coronary artery bypass graft) was planned. Subjects were assigned to IABP (n=301) or BAT (n=299). The primary efficacy end point was 30-day all-cause mortality. Secondary endpoints included hemodynamic parameters, serum-lactate, Simplified Acute Physiology Score\u2013II (SAPS-II), serial creatinine level and creatinine clearance, and inflammatory reaction (as measured by C-reactive protein). Safety assessments included major bleeding, peripheral ischemic complications, sepsis, and stroke [Thiele H et al. \u003Cem\u003EAm Heart J\u003C\/em\u003E 2012; Thiele H et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EThe median age of subjects was 70 years and 77% were men. Almost 50% had undergone resucitation (for 30 or fewer minutes) before randomization and about 80% had multivessel disease. Approximately 95% of subjects in both groups underwent primary PCI. There was a trend toward more frequent use of ventricular assist devices in the BAT group (7.4% of patients vs 3.7% in the IABP group; p=0.053); however, the duration of mechanical ventilation, the number of days in the intensive care unit, the number of subjects receiving renal replacement therapy, and the time to hemodynamic stabilization did not differ.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAt 30 days, 119 patients in the IABP group (39.7%) and 123 patients in the control group (41.3%) had died (RR with IABP, 0.96; 95% CI, 0.79 to 1.17; p=0.69). An analysis of prespecified post hoc subgroups showed no benefit for IABP based on sex, age, diabetes, or hypertension status, blood pressure (\u0026lt;80 vs \u226580 mm Hg), ST-segment elevation myocardial infarction (STEMI) versus non\u2013STEMI, or previous history of MI. The groups did not differ significantly with respect to the rates of major bleeding (3.3% vs 4.4%, respectively; p=0.51), peripheral ischemic complications (4.3% vs 3.4%; p=0.53), sepsis (15.7% vs 20.5%; p=0.15), or stroke (0.7% and 1.7%; p=0.28) [Thiele H et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2012].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EConcerning the secondary endpoints and process-of-care measures, there was an early trend toward improved SAP-II scores in the IABP group but this did not persist beyond Day 4. There was no benefit with respect to renal function or serum lactate in the IABP group and no difference in C-reactive protein levels.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EProf. Thiele concluded that while IABP support in cardiogenic shock is safe, it does not improve 30-day mortality in patients with cardiogenic shock complicating AMI who underwent early revascularization in the IABP-SHOCK II trial.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2012 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/12\/13\/16.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nznb1f\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}