Objectives: Intra-aortic balloon pump (IABP) plays a pivotal role in the treatment of cardiogenic shock (CS) complicating acute ST-segment elevation myocardial infarction (STEMI). However, the influence of IABP on the inflammatory response has not been well evaluated. We sought to assess the effects of IABP support upon C-reactive protein (CRP) levels in patients with STEMI complicated by CS undergoing percutaneous coronary intervention (PCI). Methods: This was a prospective study and a total of 91 patients with STEMI complicated by CS receiving emergency PCI were enrolled, 43 cases of which received IABP support, and the remaining cases without IABP therapy were the control group. CRP levels were determined at admission, and on days 3 and 7. Troponin I peak, left ventricular function and major adverse cardiovascular events were compared following PCI. Results: The IABP group had lower CRP levels at days 3 and 7, greater improvement in left ventricular function and lower troponin peak following PCI. Significant differences were also observed in the incidence of mortality at 6-month follow-up, both in hospital and after 30 days. Conclusions: IABP support improves clinical prognosis and attenuates the CRP level in patients with CS complicating STEMI after PCI.

1.
Hochman JS, Buller CE, Sleeper LA, Boland J, Dzavik V, Sanborn TA, Godfrey E, White HD, Lim J, LeJemtel T: Cardiogenic shock complicating acute myocardial infarction: etiologies, management and outcome: a report from the SHOCK trial registry. J Am Coll Cardiol 2000;36:1063–1070.
2.
Barron HV, Every NR, Parsons LS, Angeja B, Goldberg RJ, Gore JM, Chou TM; Investigators in the National Registry of Myocardial Infarction 2: The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2. Am Heart J 2001;141:933–939.
3.
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK; American College of Cardiology; American Heart Association Task Force on Practice Guidelines; Canadian Cardiovascular Society: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation 2004;110:e82–e292.
4.
Van de Werf F, Ardissino D, Betriu A, Cokkinos DV, Falk E, Fox KA, Julian D, Lengyel M, Neumann FJ, Ruzyllo W, Thygesen C, Underwood SR, Vahanian A, Verheugt FW, Wijns W: Management of acute myocardial infarction in patients presenting with ST-segment elevation. The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology.Eur Heart J 2003;24:28–66.
5.
Libby P, Ridker PM, Maseri A: Inflammation and atherosclerosis. Circulation 2002;105:1135–1143.
6.
Bae EH, Lim SY, Jeong MH, Park HW, Lim JH, Hong YJ, Kim W, Kim JH, Cho JG, Ahn YK, Park JC, Suh SP, Ahn BH, Kim SH, Kang JC: Long-term predictive factors of major adverse cardiac events in patients with acute myocardial infarction complicated by cardiogenic shock. Korean J Intern Med 2005; 20:8–14.
7.
Mishra S, Chu WW, Torguson R, Wolfram R, Deible R, Suddath WO, Pichard AD, Satler LF, Kent KM, Waksman R: Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention. Am J Cardiol 2006;98:608–612.
8.
Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH: Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock? N Engl J Med 1999;341:625–634.
9.
Waksman R, Weiss AT, Gotsman MS, Hasin Y: Intra-aortic balloon counterpulsation improves survival in cardiogenic shock complicating acute myocardial infarction. Eur Heart J 1993;14:71–74.
10.
Sanborn TA, Sleeper LA, Bates ER, Jacobs AK, Boland J, French JK, Dens J, Dzavik V, Palmeri ST, Webb JG, Goldberger M, Hochman JS: Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? J Am Coll Cardiol 2000;36:1123–1129.
11.
Kovack PJ, Rasak MA, Bates ER, Ohman EM, Stomel RJ: Thrombolysis plus aortic counterpulsation: improved survival in patients who present to community hospitals with cardiogenic shock. J Am Coll Cardiol 1997;29:1454–1458.
12.
Anderson RD, Ohman EM, Holmes DR Jr, Col I, Stebbins AL, Bates ER, Stomel RJ, Granger CB, Topol EJ, Califf RM: Use of intraaortic balloon counterpulsation in patients presenting with cardiogenic shock: observations from the GUSTO-I Study. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries. J Am Coll Cardiol 1997;30:708–715.
13.
Low R: Intra-aortic balloon counterpulsation in acute myocardial infarction: too few or too many? J Am Coll Cardiol 2003;41:1946–1947.
14.
Ohman EM, Nanas J, Stomel RJ, Leesar MA, Nielsen DW, O’Dea D, Rogers FJ, Harber D, Hudson MP, Fraulo E, Shaw LK, Lee KL; TACTICS Trial: Thrombolysis and counterpulsation to improve survival in myocardial infarction complicated by hypotension and suspected cardiogenic shock or heart failure: results of the TACTICS Trial. J Thrombosis Thrombolysis 2005;19:33–39.
15.
Sjauw KD, Engström AE, Vis MM, van der Schaaf RJ, Baan J Jr, Koch KT, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP: A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J 2009;30:459–468.
16.
Prondzinsky R, Lemm H, Swyter M, Wegener N, Unverzagt S, Carter JM, Russ M, Schlitt A, Buerke U, Christoph A, Schmidt H, Winkler M, Thiery J, Werdan K, Buerke M: Intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: the prospective, randomized IABP SHOCK trial for attenuation of multiorgan dysfunction syndrome. Crit Care Med 2010;38:152–160.
17.
Dimitrijevic O, Stojcevski BD, Ignjatovic S, Singh NM: Serial measurements of C-reactive protein after acute myocardial infarction in predicting one-year outcome. Int Heart J 2006;47:833–842.
18.
Dibra A, Mehilli J, Braun S, Hadamitzky M, Baum H, Dirschinger J, Schühlen H, Schömig A, Kastrati A: Inflammatory response after intervention assessed by serial C-reactive protein measurements correlates with restenosis in patients treated with coronary stenting. Am Heart J 2005;150:344–350.
19.
Akkus MN, Polat G, Yurtdas M, Akcay B, Ercetin N, Cicek D, Doven O, Sucu N: Admission levels of C-reactive protein and plasminogen activator inhibitor-1 in patients with acute myocardial infarction with and without cardiogenic shock or heart failure on admission. Int Heart J 2009;50:33–45.
20.
Onorati F, Santarpino G, Tangredi G, Palmieri G, Rubino AS, Foti D, Gulletta E, Renzulli A: Intra-aortic balloon pump induced pulsatile perfusion reduces endothelial activation and inflammatory response following cardiopulmonary bypass. Eur J Cardiothorac 2009;35:1012–1019.
21.
Roubille F, Cayla G, Picot MC, Pradet V, Massin F, Gervasoni R, Pasquie JL, Macia JC, Piot C, Leclercq F: C-reactive protein (CRP) after revascularized STEMI: is CRP a prognostic factor? Rev Med Interne 2008;29:868–874.
22.
Hoffmann R, Suliman H, Haager P, Christott P, Lepper W, Radke PW, Ortlepp J, Blindt R, Hanrath P, Weber C: Association of C-reactive protein and myocardial perfusion in patients with ST-elevation acute myocardial infarction. Atherosclerosis 2006;86:177–183.
23.
Majstorov V, Pop Gjorceva D, Vaskova O, Vavlukis M, Peovska I, Maksimovic J, Kuzmanovska S, Zdraveska-Kocovska M: C-reactive protein in patients with normal perfusion and mild to moderate perfusion defects who have undergone myocardial perfusion imaging with 99m-Tc sestamibi gated spect. Prilozi 2008;29:67–76.
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