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Updated: Aug 6, 2026
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention
Sundeep Mishra1, William W Chu, Rebecca Torguson
1Division of Cardiology, Washington Hospital Center, Washington, DC, USA.
Insights
Prophylactic intra-aortic balloon pump (IABP) use in high-risk percutaneous coronary interventions (PCIs) improves outcomes. Patients receiving a prophylactic IABP had lower mortality and major adverse cardiac events at six months compared to those needing a rescue IABP.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Intra-aortic balloon pump (IABP) use is established for hemodynamic support during high-risk percutaneous coronary interventions (PCIs).
- Longer-term outcomes for prophylactic versus rescue IABP strategies in high-risk PCI patients remain incompletely understood.
Purpose of the Study:
- To compare the clinical outcomes of high-risk PCI patients who received a prophylactic IABP (P-IABP) versus those who required a rescue IABP (R-IABP) due to intraprocedural complications.
Main Methods:
- A comparative study of 68 patients undergoing high-risk PCI with P-IABP versus 46 patients requiring R-IABP.
- Exclusion criteria included cardiogenic shock, acute ST-segment elevation myocardial infarction, and mechanical ventilation.
- Outcomes assessed included procedural success, in-hospital mortality, major complications, and 6-month mortality and major adverse cardiac events.
Main Results:
- The P-IABP group demonstrated higher procedural success rates and lower in-hospital mortality and major complications compared to the R-IABP group.
- At 6 months, the P-IABP group had significantly lower mortality (8% vs. 29%) and major adverse cardiac event rates (12% vs. 32%).
- Prophylactic IABP insertion was identified as the sole independent predictor of 6-month survival. Vascular complication rates were low, with higher major bleeding in the R-IABP group.
Conclusions:
- Prophylactic IABP support in high-risk PCI patients is associated with favorable short-term and 6-month outcomes compared to rescue IABP.
- Liberal consideration of prophylactic IABP use in selected high-risk PCI patients is warranted to improve survival and reduce adverse events.
Abstract:
Intra-aortic balloon pump (IABP) has been shown to support patients who are at high risk for percutaneous coronary interventions (PCIs) or becoming hemodynamically unstable during PCI, but the longer term outcomes of these strategies are unknown. This study investigated the outcomes of high-risk patients who received a prophylactic IABP (P-IABP) versus patients who required rescue IABP (R-IABP) because of intraprocedural complications. Clinical outcomes of 68 consecutive patients (69 procedures) who underwent high-risk PCI with P-IABP support were compared with those of 46 patients who required R-IABP. Patients who presented with cardiogenic shock or acute ST-segment elevation myocardial infarction, and those who were on mechanical ventilators were excluded. Clinical baseline characteristics were similar between groups except for more diabetics and patients with hypercholesterolemia in the P-IABP group. The procedural success was higher in the P-IABP group, with lower in-hospital mortality and major complications, than in the R-IABP group. At 6 months, the mortality and major adverse cardiac event rates were lower in the P-IABP group (8% vs 29%, p < 0.01, and 12% vs 32%, p = 0.02, respectively). Multivariate analysis showed that prophylactic insertion of an IABP is the only independent predictor of survival at 6 months. The incidence of vascular complications was low and comparable except for more major bleeding (15% vs 3%, p = 0.03) in the R-IABP group. In conclusion, patients who undergo high-risk PCI and then receive P-IABP support have favorable outcomes compared with those who require R-IABP for intraprocedural complications. Therefore, in high-risk patients undergoing PCI, liberal use of a P-IABP should be considered.
