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Updated: Sep 16, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Prophylactic Intra-Aortic Balloon Pump Implantation Reduces Peri-Interventional Myocardial Injury During High-Risk
Sascha d'Almeida1, Stefanie Andreß1, Sebastian Weinig1
1Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, Ulm University Hospital, 89075 Ulm, Germany.
Insights
Prophylactic intra-aortic balloon pump (IABP) use before high-risk percutaneous coronary interventions (PCI) reduces myocardial injury and improves survival in select patients. This strategy is particularly beneficial for patients with low systolic blood pressure and elevated NT-proBNP levels.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomarker Research
Background:
- Intra-aortic balloon pump (IABP) therapy is utilized to augment coronary perfusion during high-risk percutaneous coronary interventions (PCI).
- Distinguishing the benefits of prophylactic IABP (P-IABP) versus rescue IABP (R-IABP) is crucial for optimizing patient outcomes.
Purpose of the Study:
- To identify patient subgroups who benefit from prophylactic IABP (P-IABP) compared to rescue IABP (R-IABP) during high-risk PCI.
- To investigate baseline characteristics associated with peri-interventional myocardial injury and their correlation with IABP timing.
Main Methods:
- A retrospective analysis of non-cardiogenic shock patients undergoing high-risk PCI with IABP support (2012-2020).
- Patients were categorized into pre-interventional P-IABP or peri-interventional R-IABP groups.
- Primary endpoint: peri-interventional high-sensitivity Troponin T (hsTnT) increase; secondary analysis of baseline characteristics and survival.
Main Results:
- P-IABP was associated with a significantly lower peri-interventional hsTnT increase compared to R-IABP (p=0.008).
- In the R-IABP group, ST-segment elevation, low systolic blood pressure, and elevated NT-proBNP levels correlated with higher hsTnT increases.
- P-IABP demonstrated a smaller hsTnT increase in patients with low systolic blood pressure and high NT-proBNP levels, associated with improved survival (p=0.046).
Conclusions:
- Prophylactic IABP use in high-risk PCI is linked to reduced myocardial injury (lower hsTnT) and improved survival.
- Patients with low systolic blood pressure and elevated NT-proBNP levels are key candidates who benefit from P-IABP.
- These specific patient profiles should be considered when deciding on prophylactic IABP indication.
Abstract:
Background: Intra-aortic balloon pump (IABP) augments coronary perfusion during high-risk percutaneous coronary interventions (PCI). We sought to identify patients who benefited from prophylactic IABP (P-IABP) compared to rescue-IABP (R-IABP). Methods: All consecutive non-cardiogenic shock patients undergoing high-risk PCI with IABP support at Ulm University Hospital, Germany, between 2012 and 2020 were grouped based on the timing of IABP insertion in the pre-interventional P-IABP or peri-interventional R-IABP group. We compared the primary endpoint peri-interventional high-sensitivity Troponin T (hsTnT) increase, sought baseline characteristics associated with the endpoint in the R-IABP group, and compared their correlation strengths between the groups. Results: Interventional outcomes of 44 patients with P-IABP implantation were compared with those of 15 patients with R-IABP implantation. P-IABP was associated with a lower peri-interventional hsTnT increase (p = 0.008, r = 0.390). In the R-IABP group, the presence of ST-segment elevation (p = 0.037, r = 0.631), low systolic blood pressure (RRsyst) (p = 0.007, r = 0.893 (inverse correlation)), and elevated NT-proBNP levels (p < 0.001, r = 0.953) were associated with higher hsTnT increases. HsTnT increase was significantly smaller in the P-IABP group in patients with low RRsyst (IZI = 2.6) and high NT-proBNP levels (IZI = 3.36). Patients with RRsyst < 120 mmHg (p = 0.007) and NT-proBNP levels ≥ 900 pg/mL (Cohen's d = 0.70, respectively 1.17 for ≥5000 pg/mL and 5.01 for ≥10,000 pg/mL) showed lower peri-interventional hsTnT increase when treated with P-IABP compared to R-IABP, while patients with NT-proBNP levels < 900 pg/mL showed a contrary effect (Cohen's d = -0.90). Cox regression analysis showed that a high peri-interventional hsTnT increase was significantly associated with a shorter survival time (p = 0.046). Conclusions: P-IABP use in high-risk PCI was associated with reduced peri-interventional myocardial injury, as measured by lower hsTnT increase, which was associated with improved survival in patients with low systolic blood pressure and elevated NT-proBNP levels. Thus, these conditions should be considered for indicating P-IABP.
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