Impact of intraaortic balloon counterpulsation in patients with acute myocardial infarction and cardiogenic shock

Abstract

Purpose: Intraaortic balloon counterpulsation (IABP) is recommended for acute myocardial infarction (MI) patients who presenting with cardiogenic shock. Recently, a randomized trial revealed that IABP support did not reduce 30-day mortality. We aimed to determine the impact of IABP support on the short- and long-term mortality. Methods: A total of 774 patients with acute MI and cardiogenic shock were selected from the Korea Working Group on Myocardial Infarction Registry between December 2007 and December 2010. Primary outcomes were mortality at one-month and one-year. Results: The patients who were treated with IABP support was 395 and the patients not treated with IABP was 379. The patients treated with IABP were more ST-segment elevation myocardial infarction, anterior ischemia on electrocardiogram, and had undergone more PCI and coronary artery bypass surgery than patients not treated with IABP. Infarct area was larger and rate of statin prescription during hospitalization was higher in patients treated with IABP. One-month mortality and one-year mortality were significantly lower in patients treated with IABP compared to patients not treated with IABP (45.3 vs 54.6%, p=0.024; 46.8 vs 55.4%, p=0.041, respectively). By multivariate logistic regression analysis after adjusting confounding variables, IABP support was associated with neither one-month mortality nor one-year mortality (OR 0.62, 95% CI 0.348-1.098, p=0.101; OR 0.64, 95% CI 0.382-1.085, p=0.098, respectively). However, Cox proportional hazard model showed that long-term survival was significantly better in patients treated with IABP (log rank p=0.034). ![Figure][1] Conclusions: This study showed that IABP support was not associated with reduced one-month mortality but associated with long-term mortality benefit. [1]: pending:yes