Intra-aortic balloon counterpulsation: current evidence-based and unresolved issues

Abstract

This literature review provides the current evidence-based research regarding the role of intra-aortic balloon counterpulsation in the treatment of patients in various clinical situations. These include patients with acute coronary syndrome, complicated or uncomplicated by cardiogenic shock, accompanied by high-risk percutaneous coronary interventions, accompanying patients in need of coronary artery bypass surgery in various conditions as a ‘bridge’ to decision-making or treatment. Because the introduction of intra-aortic balloon counterpulsation into clinical practice, it has been the most common method of hemodynamic support in high-risk patients. The classical strategy for the treatment of acute myocardial infarction has evolved over the last decade from a thrombolysis scenario to a primary coronary revascularisation scenario, which resulted in a larger patient cohort. The currently available data, however, do not support the routine use of intra-aortic balloon counterpulsation by most of this population. Current studies have shown that the use of intra-aortic balloon counterpulsation did not lead to a decrease in 30-day mortality in patients with acute coronary syndrome and cardiogenic shock who received therapy with the strategy of early myocardial revascularisation as the planned primary goal. The expediency of using high-risk percutaneous coronary intervention as an accompanying method is ambiguous, whereas the use of the method as a ‘bridge’ to surgical myocardial revascularisation may be justified and requires additional research. The article provides the current recommendations for the treatment of patients. Research results and unresolved issues are being discussed.Received 3 June 2020. Revised 4 August 2020. Accepted 24 August 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.