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Updated: Jul 12, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Beneficial Effects of IABP in Anterior Myocardial Infarction Complicated by Cardiogenic Shock
Alberto Somaschini1,2, Stefano Cornara1,2, Sergio Leonardi2,3
1Cardiac Intensive Care Unit, Division of Cardiology, San Paolo Hospital, 17100 Savona, Italy.
Insights
Intra-aortic balloon pump (IABP) use may improve survival in ST-elevation myocardial infarction (STEMI) patients with cardiogenic shock (CS), particularly those with anterior infarction. Further research is needed to confirm these findings.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Recent guidelines suggest reduced routine use of intra-aortic balloon pumps (IABP) for ST-elevation myocardial infarction (STEMI) with cardiogenic shock (CS).
- Clinical practice shows persistent high utilization of IABP despite guideline changes.
Purpose of the Study:
- To assess the prognostic effect of IABP in STEMI patients experiencing CS undergoing primary percutaneous coronary intervention (pPCI).
- To specifically investigate the impact of IABP in anterior myocardial infarction (MI) cases, where benefits were previously suggested.
Main Methods:
- A cohort of 2958 patients undergoing pPCI for STEMI between 2005 and 2018 was analyzed.
- Propensity score matching and mortality analyses were employed to evaluate outcomes.
Main Results:
- Cardiogenic shock (CS) occurred in 8.3% of patients, with 60% having anterior acute myocardial infarction (AMI).
- In propensity-matched analysis, IABP use was linked to significantly lower 30-day mortality (39.3% vs. 60.9%, p=0.032) specifically in anterior STEMI patients.
- No significant mortality impact was observed for IABP in the overall CS group or in non-anterior STEMI subgroups.
Conclusions:
- Intra-aortic balloon pump (IABP) use demonstrated improved survival in STEMI patients with CS and anterior infarction.
- Further prospective studies are warranted to guide definitive decisions on IABP use in this critical patient population.
Abstract:
Background and Objectives. Recent guidelines have downgraded the routine use of the intra-aortic balloon pump (IABP) in patients with cardiogenic shock (CS) due to ST-elevation myocardial infarction (STEMI). Despite this, its use in clinical practice remains high. The aim of this study was to evaluate the prognostic impact of the IABP in patients with STEMI complicated by CS undergoing primary PCI (pPCI), focusing on patients with anterior MI in whom a major benefit has been previously hypothesized. Materials and Methods. We enrolled 2958 consecutive patients undergoing pPCI for STEMI in our department from 2005 to 2018. Propensity score matching and mortality analysis were performed. Results. CS occurred in 246 patients (8.3%); among these patients, 145 (60%) had anterior AMI. In the propensity-matched analysis, the use of the IABP was associated with a lower 30-day mortality (39.3% vs. 60.9%, p = 0.032) in the subgroup of patients with anterior STEMI. Conversely, in the whole group of CS patients and in the subgroup of patients with non-anterior STEMI, IABP use did not have a significant impact on mortality. Conclusions. The use of the IABP in cases of STEMI complicated by CS was found to improve survival in patients with anterior infarction. Prospective studies are needed before abandoning or markedly limiting the use of the IABP in this clinical setting.
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