Intraaortic balloon pump use in high-risk percutaneous coronary intervention

Abstract

Despite the long-term availability and clinical usage of intraaortic balloon pump (IABP) counterpulsation, there is a paucity of randomized trial evidence for its use. Here, we will review the latest evidence for its usage in different clinical settings. There have been decades of nonrandomized and observational data available, but only in the last 3 years has there been availability of randomized evidence for IABP use in acute myocardial infarction (AMI) with cardiogenic shock, ST elevation acute coronary syndromes (STE-ACS) without shock and high-risk percutaneous coronary intervention (PCI) cohorts. To the surprise of many, despite the sound physiological benefits achieved by the use of IABP counterpulsation in these situations, all the recent trials did not achieve the primary endpoint, although there is a trend towards long-term benefit with its use. This may alter its elective use in practice and may lead to changes in current guidance and possibly increase the focus on other mechanical circulatory devices. Despite the neutral primary endpoints in these recent trials, there is a signal that a subset of the population may benefit by elective IABP use and get good haemodynamic support, thus suggesting, in our view, that further understanding and research are required to gain maximum physiological benefit from this device and to aid decision making for an individualized, patient-centred approach.