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Published on: June 12, 2021
Use of intraaortic balloon pump in cardiogenic shock patients
Insights
Intra-aortic balloon pump (IABP) use in cardiogenic shock (CS) shows high mortality despite mechanical support. Increased vasoactive inotropic score and mechanical complications predict 30-day mortality in CS patients.
Area of Science:
- Cardiology
- Intensive Care Medicine
- Mechanical Circulatory Support
Background:
- Cardiogenic shock (CS) remains a critical condition with high mortality.
- The role of intra-aortic balloon pump (IABP) in managing CS has been debated.
- A 10-year single-centre experience with IABP in CS is analyzed to identify mortality predictors.
Purpose of the Study:
- To describe a decade-long experience with IABP in cardiogenic shock.
- To identify risk factors associated with 30-day mortality in CS patients treated with IABP.
Main Methods:
- Retrospective, observational study of 10 years of IABP use in CS patients.
- Data collected from January 2012 to May 2022 at a single tertiary care center.
- Multivariable and Cox regression analyses were performed to identify predictors of 30-day mortality.
Main Results:
- The primary cause of CS was acute myocardial infarction (86%), leading to new-onset heart failure (87%).
- In-hospital mortality was 39%, and 30-day mortality was 43%.
- Elevated vasoactive inotropic score on day 5 and mechanical complications were significant predictors of 30-day mortality.
Conclusions:
- Despite IABP implementation, high in-hospital and 30-day mortality rates persist in CS patients.
- Vasoactive inotropic score and mechanical complications are key factors influencing 30-day survival.
- Further research is needed to improve outcomes for CS patients requiring mechanical circulatory support.
Background And Objectives:
The relevance of the use of intra-aortic balloon pump (IABP) in cardiogenic shock (CS) has been discussed over the past years. The aim of this study is to describe a single-centre 10-year experience with IABP and analyse the risk factors for 30-day mortality.
Methods:
The data for this single-centre, observational, retrospective study were drawn from records dated from January 2012 to May 2022 pertaining to patients presenting with CS, treated with IABP and hospitalised at the Department of Acute Cardiology, Institute for Clinical and Experimental Medicine, Prague.
Results:
Among the patients included in the study, 87% patients presented with newly developed heart failure. The leading cause of CS was acute myocardial infarction accounting for 86% of cases. Hospital mortality was recorded at 39% and the 30-day mortality reached 43%. Upon multi-variable analysis, only the vasoactive inotropic score on day 5 emerged as a statistically significant predictor for 30-day mortality (p=0.0055). Cox regression analysis revealed that the presence of mechanical complications was the only variable identified as yielding a statistically significant impact on the 30-day survival (Log-rank p=0.014, HR 2.19, 95% CI: 1.15‒4.15). There was no statistically significant difference in the 30-day mortality across the SCAI classes.
Conclusion:
The main cause of CS was a newly developed acute heart failure secondary to acute myocardial infarction. Despite the implementation of mechanical circulatory support, both in-hospital and 30-day mortality rates remained high. Increased vasoactive inotropic score and presence of mechanical complications were identified as significant predictors the 30-day survival (Tab. 6, Fig. 1, Ref. 36). Text in PDF www.elis.sk Keywords: cardiogenic shock, IABP, risk factors, mortality, Czech Republic, AMICS.
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