Background
IABP SHOCK II trial jeopardize the use of intra-aortic balloon counter pulsation
(IABP) in acute myocardial infarction (AMI).
Objectives: Aim of this study was to investigate whether or not its use improves outcomes of
patients with cardiogenic shock (CS) in acute myocardial infarction patients as compared to the accessible best medical therapy alone
Methods
In this prospectively selected cohort of equal number of CS patients with and without IABP undergone revascularization at a tertiary care cardiac center were compared for cumulative major adverse cardiac events (MACE) within 30-days.
Patients with congenital heart disease, valvular heart diseases, peripheral vascular disease, severe aortic regurgitation, resuscitated for more than 30 minutes, CS due to mechanical causes, and late arrivals (>12 hours) were excluded
Results
A total of 134 patients in the IABP group and 134 in the control group were included in the analysis of the primary end point. At 30 days, 45 patients in the IABP group (33.6%) and 42 patients in the control group (31.3%) had died (relative risk with IABP, 0.96; 95% confidence interval, 0.79 to 1.17; P=0.696. Cumulative 30-day MACE (38.8% vs. 32.1%; p=0.25) rates were not significantly different for IABP and non-IABP group.
While, cumulative 30-days bleeding events were significantly higher in IABP group with odds ratio
of 5.32 [1.14-24.77]; p=0.03
Conclusions
Best accessible medical therapy is non inferior to an IABP in acute myocardial infarction cardiogenic shock patients, in whom primary PCI is performed timely. However placement of an IABP puts patient at increased risk of moderate to severe bleeding.
