Multi-vessel coronary artery disease Circulatory System Chronic ischaemic heart disease
Conditions
Interventions
In brief patients in the elective group will have the IABP inserted at the start of the procedure, before coronary intervention. Unless prolonged use is clinically indicated, the IABP will be removed
Sponsors
British Cardiovascular Intervention Society
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Patients at least 18 years of age 2. Proposed single or multi-vessel percutaneous intervention to native coronary arteries or coronary bypass grafts 3. Presence of BOTH the following high risk features: 3.1. Impaired Left Ventricular (LV) function: Ejection Fraction (EF) less than 30% (quantified by echocardiography or LV angiography) 3.2. Large area of myocardium at risk, either unprotected left main stem target lesion or Jeopardy Score more than or equal to eight, or target vessel provides collateral supply to an occluded second vessel which supplies more than 40% of myocardium 4. Written informed consent
Exclusion criteria
Exclusion criteria: 1. Shock (systolic Blood Pressure [BP] less than 85 mmHg despite correction of hypovolaemia) 2. Acute myocardial infarction within previous 48 hours defined as: 2.1. chest pain or equivalent symptoms consistent with acute myocardial infarction, and 2.2. New ST segment elevation of at least 1 mm in two or more contiguous Electrocardiogram (ECG) leads, persisting for more than 15 minutes, or new left bundle branch block on ECG persisting for more than 15 minutes 3. Planned staged intervention procedure within 28 days of index PCI 4. Ventricular Septal Defect (VSD)/Mitral Regurgitation (MR) or intractable Ventricular Tachycardia and Ventricular Fibrillation (VT/VF) post Myocardial Infarction (MI) 5. Thoracic/abdominal aortic disease 6. Significant ilio-femoral artery disease (documented on Doppler studies or ilio-femoral angiography or absent femoral pulses bilaterally), the presence of clinical signs of acute leg ischaemia and previous bilateral femoral bypass graft surgery 7. More than mild aortic regurgitation on echocardiography 8. Bleeding diathesis or Warfarin therapy with International Normalised Ratio (INR) more than 2.5 9. Active internal bleeding (except menstruation) 10. Allergy to aspirin, clopidogrel, heparin or Glycoprotein (GP) IIb/IIIa inhibitors 11. Thrombocytopenia (platelet count less than 100,000 cells/mm^3) 12. Women who are pregnant 13. Patients who have previously been enrolled in this study
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Comparison of Major Adverse Cardiovascular Events (MACE) at hospital discharge or 28 days whichever is sooner. MACE includes death, myocardial infarction, cerebrovascular accident and repeat revascularisation. | — |
Secondary
| Measure | Time frame |
|---|---|
| 1. Mortality at six months 2. Procedural success 3. Procedural complications 4. Bleeding complications 5. Access site complications 6. Transient ischaemic attacks 7. Length of hospital stay | — |
Countries
England, United Kingdom
Outcome results
None listed