Beneficial Effects of IABP in Anterior Myocardial Infarction Complicated by Cardiogenic Shock

Medicina (Kaunas). 2023 Oct 11;59(10):1806. doi: 10.3390/medicina59101806.

Abstract

Background and Objectives. Recent guidelines have downgraded the routine use of the intra-aortic balloon pump (IABP) in patients with cardiogenic shock (CS) due to ST-elevation myocardial infarction (STEMI). Despite this, its use in clinical practice remains high. The aim of this study was to evaluate the prognostic impact of the IABP in patients with STEMI complicated by CS undergoing primary PCI (pPCI), focusing on patients with anterior MI in whom a major benefit has been previously hypothesized. Materials and Methods. We enrolled 2958 consecutive patients undergoing pPCI for STEMI in our department from 2005 to 2018. Propensity score matching and mortality analysis were performed. Results. CS occurred in 246 patients (8.3%); among these patients, 145 (60%) had anterior AMI. In the propensity-matched analysis, the use of the IABP was associated with a lower 30-day mortality (39.3% vs. 60.9%, p = 0.032) in the subgroup of patients with anterior STEMI. Conversely, in the whole group of CS patients and in the subgroup of patients with non-anterior STEMI, IABP use did not have a significant impact on mortality. Conclusions. The use of the IABP in cases of STEMI complicated by CS was found to improve survival in patients with anterior infarction. Prospective studies are needed before abandoning or markedly limiting the use of the IABP in this clinical setting.

Keywords: IABP; acute myocardial infarction; cardiogenic shock; mechanical circulatory support.

MeSH terms

  • Humans
  • Intra-Aortic Balloon Pumping / adverse effects
  • Intra-Aortic Balloon Pumping / methods
  • Myocardial Infarction*
  • Non-ST Elevated Myocardial Infarction* / etiology
  • Percutaneous Coronary Intervention* / methods
  • ST Elevation Myocardial Infarction* / complications
  • ST Elevation Myocardial Infarction* / surgery
  • Shock, Cardiogenic / complications
  • Shock, Cardiogenic / surgery
  • Treatment Outcome

Grants and funding

This research received no external funding.