Intra-Aortic Balloon Pump Use in Post-Infarction Ventricular Septal Rupture: The Impact of Timing Relative to...

Area of Science:

• Cardiology
• Cardiovascular Surgery
• Critical Care Medicine

Background:

• Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) can lead to cardiogenic shock (CS) and dramatically increased mortality.
• Intra-aortic balloon pumps (IABPs) are used for VSR management, but their optimal timing relative to CS onset is unclear.

Purpose of the Study:

• To investigate the impact of intra-aortic balloon pump (IABP) timing on survival in patients with acute myocardial infarction-related ventricular septal rupture (AMI-VSR).
• To determine if initiating IABP before cardiogenic shock (CS) onset improves outcomes compared to post-CS or no IABP use.

Main Methods:

• Retrospective analysis of 124 patients with AMI-VSR from 2009-2024.
• Patients were categorized into pre-CS IABP, post-CS IABP, and no-IABP groups based on IABP initiation relative to CS onset (defined by catecholamine administration).
• Primary outcome was 90-day all-cause mortality, analyzed using Kaplan-Meier curves and Cox proportional hazards models, with subgroup analysis by CS status.

Main Results:

• 90-day survival rates were 68.2% (pre-CS IABP), 14.3% (post-CS IABP), and 35.1% (no-IABP).
• Early IABP use (pre-CS) was associated with significantly lower mortality compared to no-IABP and post-CS IABP groups.
• In patients with CS, IABP use showed no survival benefit (19.4% vs. 17.6%); however, among non-CS patients, IABP use was independently associated with lower mortality (85.7% vs. 50.0%).

Conclusions:

• Early IABP initiation in AMI-VSR patients may improve short-term survival, particularly before the onset of cardiogenic shock.
• The survival benefit of IABP was not observed once cardiogenic shock had developed.
• Findings suggest the importance of early risk stratification and timely hemodynamic support for high-risk AMI-VSR patients.