Abstract P155: Perioperative Intra-Aortic Balloon Pump Counterpulsation and Outcomes in Very Elderly
Bibliographic record
Abstract
Introduction: Indications for use of intra aortic balloon pump (IABP)are low ejection fraction, shock, left main stem disease, unstable angina, refractory angina and redo operation. These were supported by trials which included few very elderly patients (older than 80). Octogenarians are increasingly undergoing Coronary artery bypass surgery often needing IABP use. Hypothesis: we plan to test the utility and effectiveness of IABP in improving outcomes in very elderly patients undergoing isolated coronary artery bypass grafting (CABG). Methods: We performed a retrospective analysis of very elderly patients who underwent coronary artery bypass from 01/2001 to 12/2008. Statistical analysis is performed by STATA. Results: A total of 450 patients older than 80 underwent CABG during eight years. The mean age of the total subjects was 83.16+/- 2.48. A total of 35 (7.78%) patients underwent perioperative IABP of whom 14 (40%) died. Mortality among Non-IABP group was 7.47% (31/415).This was statistically significant at p<0.000.Higher mortality in IABP group was seen across all the subset of patients with accepted guideline based indication including shock, low EF, Left main stem disease, Unstable angina. Higher mortality was also seen in other risk factors like CHF, renal failure. Patients who underwent IABP placement experienced other adverse outcomes like longer mean extubation time of 151.6 hrs (CI 24-301 ) compared to 27.03 hrs ( CI 19 - 34.07) in Non-IABP group. Need for more than two inotropes was 44% (11/25) in IABP whereas it was 4.84 % (17/351) in Non-IABP group. No clear relation to postoperative atial fibrillation was found. Post operative renal failure was 9.38 (3/32) in IABP group compared to 2.24(9/401) in Non IABP group with a p <.01.We didn't had enough power to look into post-operative Cerebrovascular accident. In multivariate regression analysis after adjustment for confounding variable placement IABP has higher mortality with an OR 2.31 (1.14-3.48) p<.0001 Conclusions: In very elderly patients mortality rate is very high even for indications supported by ACC/AHA guidelines. We need prospective studies focusing on very elderly patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| 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) | 0.004 | 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 source (direct Gemma or distilled Codex), 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".