• Edward Litton, Frances Bass, Anthony Delaney, Graham Hillis, Silvana Marasco, Shay McGuinness, Paul S Myles, Christopher M Reid, Julian A Smith, and PINBALL study investigators and the ANZICS CTG.
• Fiona Stanley Hospital, Perth, WA, Australia. Electronic address: ed.litton@health.wa.gov.au.
• J. Cardiothorac. Vasc. Anesth. 2018 Oct 1; 32 (5): 2067-2073.

ObjectiveTo inform the design of a pivotal randomized controlled trial of prophylactic intra-aortic balloon counterpulsation (IABC) in patients undergoing coronary artery bypass graft (CABG) at high risk of postoperative low cardiac output syndrome (LCOS).DesignInception cohort study.SettingA total of 13 established cardiac centers in Australia, Canada, New Zealand, and the United Kingdom.ParticipantsAdult patients were eligible for inclusion if they were listed for CABG surgery and had 2 or more LCOS risk factors (low ejection fraction, severe left main coronary artery disease, redo sternotomy, unstable angina).InterventionsOutcomes of interest were a composite outcome of in-hospital mortality, postoperative acute myocardial infarction (AMI), acute kidney injury (AKI), or stroke as well as 6-month vital status and quality of life using the EuroQol 5-dimensional questionnaire (EQ5D).Measurements And Main ResultsThe study included 136 participants over a 29-month period. Overall, in-hospital and 6-month mortality occurred in 7 (5%) and 11 (8%) participants, respectively. The composite outcome occurred in 60 (44%). The mean increase in EQ5D summary index at 6 months was 0.10 (standard deviation 0.24, p = 0.01). Perioperative AMI, AKI, or stroke significantly decreased the odds of a clinically meaningful improvement in quality of life (odds ratio 0.32; 95% confidence interval 0.13-0.79; p = 0.014). Preoperative IABC was used in 39 participants and did not predict postoperative outcomes.ConclusionsThe study identified a group of patients at risk of LCOS in whom CABG surgery was associated with a substantial burden of perioperative morbidity. Preoperative IABC use was variable, supporting the need for further research.Copyright © 2018 Elsevier Ltd. All rights reserved.

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