Trends in Intra-Aortic Balloon Pump Use in Cardiogenic Shock After the SHOCK-II Trial

Area of Science:

• Cardiology
• Interventional Cardiology
• Critical Care Medicine

Background:

• Myocardial infarction complicated by cardiogenic shock (MI-CS) carries a high mortality rate.
• Intra-aortic balloon pump (IABP) was previously considered beneficial but recent trials question its survival benefit.
• Understanding current trends in IABP use for MI-CS is crucial for clinical practice.

Purpose of the Study:

• To analyze trends in intra-aortic balloon pump (IABP) utilization in patients with myocardial infarction and cardiogenic shock (MI-CS) undergoing percutaneous intervention.
• To evaluate the association between IABP use and short-term and long-term mortality.
• To assess the impact of IABP on major adverse cardiovascular and cerebrovascular events (MACCEs) and bleeding.

Main Methods:

• Retrospective analysis of the Melbourne Interventional Group registry from 2005 to 2018.
• Inclusion of patients diagnosed with MI-CS who underwent percutaneous intervention.
• Primary outcome: trend in IABP use over time. Secondary outcomes: 30-day mortality and MACCEs.

Main Results:

• IABP was used in 43% of 1,110 MI-CS patients, more frequently in those with left main/LAD lesions, lower ejection fraction, and inotrope use.
• IABP use was linked to higher rates of bleeding and 30-day MACCE.
• While MI-CS incidence increased, IABP use declined after 2012; IABP was not associated with mortality but predicted 30-day MACCE.

Conclusions:

• Intra-aortic balloon pump (IABP) use in MI-CS is not associated with improved short- or long-term survival.
• IABP use is associated with increased short-term adverse events, including bleeding and MACCEs.
• IABP use is decreasing but remains concentrated in higher-risk MI-CS patients.