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November 24, 2010

Elective Intra-aortic Balloon Pump Placement in High-Risk Percutaneous Coronary Intervention

JAMA. 2010;304(20):2240-2242. doi:10.1001/jama.2010.1697

To the Editor: In their randomized controlled trial comparing elective intra-aortic balloon pump (IABP) counterpulsation vs no planned IABP support in high-risk percutaneous coronary intervention (PCI), Dr Perera and colleagues1 concluded that elective IABP did not reduce the incidence of major adverse cardiac and cardiovascular events (MACCE). We agree with the study design, which used composite end points analyzed over a short period, because most patients enrolled in the Balloon Pump–Assisted Coronary Intervention Study (BCIS-1) had severely impaired left ventricular systolic function and ischemic heart failure, which conferred a high risk of death within 5 years that would probably blunt any beneficial effect of IABP intervention at long-term follow-up.2,3

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