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Published on: June 12, 2021
Survival benefit of IABP in pre- versus post-primary percutaneous coronary intervention in patients with cardiogenic
Ahmed Azazy1, Walaa Abdaziz Farid2, Walid Abdu Ibrahim2
1Department of Cardiology, King Saud Medical City, Riyadh, Saudi Arabia. dr.ahmedsabry1982@gmail.com.
Insights
Early intra-aortic balloon pump (IABP) insertion before primary percutaneous coronary intervention (PPCI) significantly improves survival for acute myocardial infarction (AMI) patients with cardiogenic shock (CS). This approach reduces both in-hospital and six-month mortality rates.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Cardiogenic shock (CS) following acute myocardial infarction (AMI) is associated with high in-hospital mortality.
- Optimal timing for intra-aortic balloon pump (IABP) insertion relative to primary percutaneous coronary intervention (PPCI) in CS patients remains unclear.
Purpose of the Study:
- To evaluate the impact of IABP insertion timing (before vs. after PPCI) on hospital and short-term survival in AMI patients with CS.
Main Methods:
- Retrospective analysis of 165 patients with AMI and CS.
- Comparison of mortality rates between patients receiving IABP before PPCI versus after PPCI.
Main Results:
- Overall mortality was 48.4% (80/165 patients).
- In-hospital mortality was significantly higher in the Post-PPCI-IABP group (49.4%) compared to the Pre-PPCI-IABP group (23.8%) (P=0.001).
- Six-month mortality was also significantly higher in the Post-PPCI-IABP group (18.5%) versus the Pre-PPCI-IABP group (6.0%) (P=0.001).
Conclusions:
- Early IABP insertion prior to PPCI is associated with improved in-hospital survival.
- Pre-PPCI IABP insertion also demonstrates improved long-term survival benefits for hemodynamically unstable AMI patients.
Background:
Cardiogenic shock (CS) remains a major cause of in-hospital mortality in the setting of acute myocardial infarction (AMI). However, little evidence is available regarding the optimal order of intra-aortic balloon counter-pulsation (IABP) insertion and primary percutaneous coronary intervention (PPCI). The aim of this study was to assess the hospital and short-term survival benefits of two different IABP insertion approaches, before versus after PPCI in patients with acute myocardial infarction and cardiogenic shock.
Results:
Total mortality was 80 patients representing 48.4% of the total 165 studied patients; 60 patients died during the hospital admission period, while the remaining 20 patients died post-discharge. In-hospital mortality was significantly higher in Post-PPCI-IABP group 40 (49.4%) versus Pre-PPCI-IABP group 20 (23.8%) (P = 0.001). Moreover, the mortality difference between the two groups was sustained over six-month follow-up period, where 15 patients (18.5%) died in the Post-PPCI-IABP group, while only 5 patients 6.0% died in the Pre-PPCI-IABP (P = 0.001).
Conclusions:
Early IABP insertion before PPCI is associated with improved in-hospital and long-term survival when used for patients presenting with AMI complicated by hemodynamic instability.
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