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Intra-Aortic Balloon Pump Use in Acute Coronary Syndrome Without Cardiogenic Shock: Association With Mortality in the

Chu Fan1, Yi Zou1, Liangguo Chen1

  • 1Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|October 29, 2025
PubMed

Insights

Intra-aortic balloon pump (IABP) use in acute coronary syndrome (ACS) patients without cardiogenic shock is linked to higher in-hospital mortality. High-risk groups, including those with heart failure, face increased risks, necessitating careful patient selection.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Research

Background:

  • The use of intra-aortic balloon pump (IABP) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) without cardiogenic shock is a subject of ongoing debate.
  • Existing research presents conflicting evidence regarding the benefits and risks of IABP in this specific patient cohort.

Purpose of the Study:

  • To evaluate the association between IABP utilization and in-hospital mortality among ACS patients without cardiogenic shock undergoing PCI.
  • To identify specific patient subgroups within this population who may be at a higher risk of adverse outcomes when treated with IABP.

Main Methods:

  • A multicenter retrospective analysis of 32,863 ACS patients from the CCC-ACS Project.
  • Propensity score matching (PSM) and multivariable logistic regression were employed to control for confounding factors.
  • Subgroup analyses and a supplementary meta-analysis of 10 studies were conducted to assess risk stratification and broader literature evidence.

Main Results:

  • IABP use was associated with a significantly higher in-hospital mortality in the propensity-matched cohort (adjusted OR: 2.56).
  • Increased mortality risk with IABP was particularly evident in patients with ST-segment elevation myocardial infarction, heart failure, reduced ejection fraction, and renal impairment.
  • The meta-analysis did not reveal a significant association between IABP use and mortality (RR: 1.06).

Conclusions:

  • IABP use in ACS patients without cardiogenic shock undergoing PCI is associated with increased in-hospital mortality, especially in high-risk subgroups.
  • Findings underscore the need for meticulous patient selection for IABP therapy in this population.
  • Further research is recommended to clarify the precise clinical indications and optimize the use of IABP in ACS management.
Abstract

Keywords:
acute coronary syndromecardiogenic shockintra‐aortic balloon pumpin‐hospital mortalitypercutaneous coronary intervention

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