Editorial |

Need for Critical Reappraisal of Intra-aortic Balloon Counterpulsation

Gjin Ndrepepa, MD; Adnan Kastrati, MD
JAMA. 2011;306(12):1376-1377. doi:10.1001/jama.2011.1288.
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Despite considerable organizational, technological, and pharmacological advancements in the treatment of patients with acute ST-segment elevation myocardial infarction (STEMI) and even with percutaneous coronary intervention (PCI), the efficacy of reperfusion is still suboptimal, mortality remains high, and novel therapeutic interventions are needed. Intra-aortic balloon counterpulsation (IABC) was first used to treat cardiogenic shock1 in 1968; since then, it has been used in various clinical conditions to provide mechanical cardiac assistance. Use of IABC is associated with immediate hemodynamic effects leading to increased diastolic pressure, increased coronary perfusion pressure, and reduced left ventricular afterload. In the setting of STEMI, left ventricular unloading by IABC may prevent early infarct extension and ventricular remodeling.2 Experimental studies have shown that IABC reduces infarct size.3

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