Intra-aortic balloon pump implantation in early-stage cardiogenic shock reduces 30-day mortality in patients with ventricular septal defect following myocardial infarction.

BACKGROUND

Ventricular septal defect (VSD) is a serious mechanical complication of acute myocardial infarction, with an extremely high mortality. Intra-aortic balloon pump (IABP) has become a bridge to surgical repair. However, its effect on mortality varies partly because of shock severity.

AIMS: This study aims to evaluate the association between IABP implantation in early-stage cardiogenic shock and the 30-day all-cause mortality in patients with VSD after myocardial infarction (MI-VSD).

METHODS

The retrospective data were collected based on MI-VSD patients who were admitted to Qilu Hospital of Shandong University from 2013 to 2024. Patients were stratified according to IABP implantation. We determined the severity of shock according to the Society for Cardiovascular Angiography and Interventions (SCAI) SHOCK stage classification system. The primary outcome was all-cause mortality within 30 days after VSD. Logistic regression models were constructed to evaluate the factors associated with the 30-day all-cause mortality. We conducted subgroup analysis and assessed interaction effects to evaluate the relationship between IABP use and 30-day mortality in various subgroups. The Kaplan-Meier curves were used to determine the cumulative incidence of 30-day mortality. We also compared the long-term outcomes of the patients.

RESULTS

This study included a total of 57 patients, 33 of whom received IABP implantation. The SCAI SHOCK stage was associated with 30-day all-cause mortality. IABP implantation significantly reduced 30-day mortality in patients with SCAI SHOCK stages A/B (6.7 % versus 55.6 %; OR 0.06, 95 % CI 0.01-0.64, P = 0.020), while no significant difference was observed in stages C/D/E patients. We also found that IABP implantation effectively prevented progression to stages C/D/E in stages A/B patients. In addition, IABP treatment in SCAI SHOCK stages A/B significantly elevated the long-term survival rate.

CONCLUSIONS

Implantation of IABP in SCAI SHOCK stages A/B could reduce 30-day all-cause mortality in MI-VSD patients.