Current use and clinical benefit of intraaortic balloon support in patients with ST-elevation myocardial infarction complicated by cardiogenic shock

Abstract

Background: European guideline recommendations for the use of intraaortic balloon support in patients with STEMI complicated by cardiogenic shock have just been revised. We sought to evaluate current use and clinical benefit of intraaortic balloon support in clinical practice. Methods: Between 2007 and 2012 a total of 4065 consecutive patients presenting with STEMI were enrolled in the FITT-STEMI feasibility-trial. 6 primary percutaneous coronary intervention hospitals in Germany and 29 associated nonpercutaneous coronary intervention hospitals participated. Data from patient contact to balloon inflation were collected and analyzed. For the present study we evaluated the FITT-STEMI-trial and included all patients with STEMI complicated by cardiogenic shock in our analysis. Results: STEMI was complicated by cardiogenic shock in 10% (406/4065) of the patients. Hospital mortality in those patients was 44% (179/406). 40.4% (164/406) of the patients with STEMI complicated by cardiogenic shock were treated with intraaortic balloon counterpulsation. Hospital mortality did not differ between patients receiving or not receiving intraaortic ballon support (43.3% vs. 44.6%). Conclusion: Hospital mortality in patients with STEMI complicated by cardiogenic shock is still high, despite high use of early reperfusion therapy. Almost half of the patients admitted with STEMI complicated by cardiogenic shock received intraaortic balloon support. However, the use of intraaortic ballon support was not associated with a lower hospital mortality which supports the findings of the randomized IABP-Shock II trial.