Routine use of preoperative intra-aortic balloon pump counterpulsation (IABP) implantation in patients with left main coronary artery disease undergoing coronary revascularization surgery
Bibliographic record
Abstract
Background: Left main coronary artery disease as the only criterion for intra-aortic balloon counterpulsation implantation is an indication which evidence is limited to experts recommendations; therefore, studies that may give a higher level of evidence are required. For this reason, we developed in our institution a study that evaluated the experience in the use of IABP in patients with left main coronary artery disease undergoing coronary revascularization surgery. Objective: describe mortality, length of stay and percentage of infections and sepsis in the intensive care unit, as well as the mechanical ventilation duration in patients undergoing an elective coronary revascularization surgery with or without the use of preoperative intra-aortic balloon counterpulsation. Methods: descriptive retrospective study performed in the Santa Maria Cardiovascular Clinic in patients undergoing elective coronary revascularization surgery with or without the use of preoperative intra-aortic balloon counterpulsation between 1999 and 2003. Postoperative behaviour in patients with severe left main disease (stenosis > 50%) submitted to this surgery was observed. Results: a total of 79 patients submitted to elective surgical revascularization were analyzed. 46 underwent preoperative balloon implantation and 33 underwent surgery without previous balloon implantation. Mean age was 62 years. 67.4% of patients were 60 years or older. Main pathologies previous to surgery were arterial hypertension in 67% of the patients, and ancient acute myocardial infarction in 59%. 87% of the patients with balloon and 45.5% of those without it had severe angina (class III) before surgery. In the intensive care unit 6.5% patients with balloon were infected as well as 3% of the group without balloon (p=0,49) and sepsis was found in 4,3% of the balloon group and none in the non-balloon group (p=0,23). Mortality in the intensive care unit was 2.2% in the balloon group and 3% in the non-balloon group (p=0,06). No intrahospital mortality out of the intensive care unit was reported, nor mortality at 30 days after discharge. Main length of stay in the intensive care unit was 4,13 days in the balloon group and 2,7 in the non-balloon group, with no significant statistical difference (p=0,288). The mean IABP time was 1,32 days and no vascular complications related to its use were found. Conclusions: this study suggests that with routine use of intra-aortic balloon counterpulsation previous to elective coronary revascularization surgery in patients in whom its only indication is severe left main coronary disease, there were no benefits in terms of mortality and length of stay in the intensive care unit or with regard to the mechanical ventilation time. There was no greater risk for developing infection or sepsis in this unit.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".