Abstract 16590: Does Use of Intra-Aortic Balloon Pump Improves Outcome in Patients Admitted With Acute Coronary Syndrome and Cardiogenic Shock: An Nationwide Inpatient Sample Analysis

Abstract

Introduction: Intra-aortic balloon pump (IABP) has been shown to have a neutral effect on patients having cardiogenic shock (CS) in acute coronary syndrome (ACS). However, subgroup analysis of certain studies has shown a beneficial effect of IABP on selected populations presenting with CS. Hypothesis: IABP is associated with improved survival and less in-hospital complications in patients with ACS and CS. Methods: Nationwide Inpatient Sample 2016 and 2017 had been retrospectively analyzed to identify all patients presenting with ACS and CS (n=79260) with appropriate ICD-10-CM codes. Patients with cardiac arrest, tamponade or pulmonary embolism, free wall rupture, ventricular septal defect, severe peripheral artery disease, aortic regurgitation, age greater than 90 or less than 18 have been excluded (n=14055) to include a final population of 65,180. Among them, IABP was used in 22,725 patients. Propensity score matching using the kernel method was used to generate an adjusted odds ratio (OR). Multiple imputations are used to generate missing variables. Results: 34% of patients presenting with CS required IABP in our analysis. Patients requiring IABP are younger and more likely to be male. Patients requiring IABP have higher prevalence of hypertension, obesity, dyslipidemia, and CAD. On propensity-matched analysis, the risk of all-cause in-hospital mortality is similar between two groups regardless of IABP use (p = 0.18). IABP appears to be protective for acute kidney injury (AKI) in non-propensity matched analysis (p = 0.007). There is a higher incidence of mechanical ventilation, bleeding, blood transfusion, coronary artery dissection, hemodialysis requirement, and respiratory failure in the IABP cohort. IABP appears to be protective for complete heart block (CHB) (p = 0.016). Conclusion: IABP use is associated with increased in-hospital complications without any mortality benefit. There appears to be some benefit towards the prevention of AKI and CHB.