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Updated: Aug 8, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Intra-Aortic Balloon Pump During Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction With High
Rajeev Chauhan1, Parminder S Otaal2
1Department of Cardiology, Post Graduate Institute of Medicine and Research, Chandigarh, IND.
Insights
Intra-aortic balloon pump (IABP) support before percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) with high thrombus burden significantly reduces 30-day mortality. Early IABP initiation improves outcomes in high-risk STEMI patients.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Acute Coronary Syndromes
Background:
- Percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) with high thrombus burden presents significant risks.
- Intra-aortic balloon pump (IABP) support may improve outcomes in these complex cases.
- Limited data exist on the efficacy of IABP in STEMI patients with high thrombus burden.
Purpose of the Study:
- To evaluate the short-term outcomes of PCI with IABP support in STEMI patients who have a high thrombus burden.
- To determine if IABP has a role in improving clinical outcomes for this specific patient group.
Main Methods:
- An observational study included 30 consecutive STEMI patients with high thrombus burden undergoing PCI with IABP.
- Data collected included left ventricular ejection fraction (LVEF), 30-day mortality, and TIMI flow/perfusion parameters.
- IABP timing (pre-PCI, between angiography and PCI, post-PCI) was analyzed in relation to outcomes.
Main Results:
- Ninety-three percent of patients experienced cardiogenic shock.
- Overall 30-day mortality was 50%.
- Pre-PCI IABP initiation was associated with significantly lower 30-day mortality (35%) compared to post-PCI initiation (80%) (p=0.020).
Conclusions:
- Initiating IABP before PCI in STEMI patients with cardiogenic shock and high thrombus burden can decrease mortality.
- IABP timing is critical, with pre-PCI initiation showing a survival benefit.
- IABP did not demonstrate an effect on angiographic parameters in this study.
Background:
Percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) with high-grade thrombus is a high-risk intervention associated with poor clinical outcomes. Circulatory support with an intra-aortic balloon pump (IABP) during PCI may potentially improve coronary hemodynamics and clinical outcomes in such patients. As existing data on this situation are sparse, we did an observational study to determine short-term outcomes of PCI with IABP support in STEMI patients with high thrombus burden.
Objectives:
To determine whether IABP has a potential role in improving outcomes in patients with STEMI with high thrombus burden who are undergoing PCI.
Methods And Results:
Thirty consecutive patients of STEMI with high thrombus burden undergoing PCI with IABP assistance were included. Ninety-three percent of patients had a cardiogenic shock. Clinical and angiographic outcomes assessed include a change in left ventricular ejection fraction (LVEF), 30-day mortality, and assessment of TIMI (thrombolysis in myocardial infarction) flow, TIMI frame count, and TIMI myocardial perfusion grade in the culprit vessel. IABP was initiated before coronary angiography in 36.6% (n=11), between angiography and PCI in 30% (n=9), and after PCI in 33.3% (n=10) of patients. During the 30-day follow-up period, 50% (n=15) of patients died. 86.6% (n=13) of survivors had pre-PCI IABP initiation compared to only 46.6% (n=7) among those who died (p=0.020). With pre-PCI IABP initiation (n=20), 30-day mortality was 35% (n=7) compared to 80% (n=8) with post-PCI IABP initiation (n=10) (p=0.020).
Conclusion:
IABP initiation before PCI in STEMI complicated by cardiogenic shock and high angiographic thrombus burden can decrease mortality without any effect on angiographic parameters.
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