Intra-Aortic Balloon Pump: Overall and Temporal Trends of Comparative Effectiveness in a National Registry

Background: Although the latest studies failed to prove the benefit of routine intra-aortic balloon pump (IABP) use in patients with acute myocardial infarction (MI) presenting with cardiogenic shock, the benefit of IABP utilization in selected cases in "real world" practice is unknown.

Aims: We sought to follow temporal trends in IABP use in a real-world cohort of acute coronary syndrome (ACS).

Methods: We evaluated IABP utilization and patient outcomes from the Acute Coronary Syndrome in Israel Survey (ACSIS) between the years 2000 and 2021. Temporal trends and outcomes with IABP at two time periods were set: early (before 2012) and late (after 2012).

Results: Out of 18,662 ACS patients, 3.7% received IABP. The rate of IABP use was 4.5% in the early period and decreased to ~2.5% in the late period (p < 0.001). Patients treated with IABP in the early period had more frequently reduced ejection fraction (64.5% vs. 53.2%, p < 0.01) and presented mostly with ST-elevation MI (71.0% vs. 62.4%, p = 0.04). Cardiogenic shock on admission and in-hospital occurred equally in both periods (14.6% vs. 17.1%, p = 0.66; 42.8% vs. 41.9%, p = 0.90, respectively). Thirty-day mortality and MACE were comparable between time periods (28% vs. 30.7%, p = 0.547; 43.6% vs. 44.1%, p = 0.978, respectively) however bleeding complications were significantly higher in the later period (4.8% vs. 11.2%, p = 0.04).

Conclusions: Our real-world ACS data demonstrated a 50% reduction in the utilization of IABP among acute MI patients in the last decade. A comparable poor prognosis with IABP across time periods, suggest sustainable worse outcome in routine albeit selective clinical practice.