Early Intra-Aortic Balloon Pump Support and In-Hospital Mortality in Patients with LV Dysfunction and Cardiogenic Shock Complicating AMI.

Background

Despite advancements in mechanical support (MCS) devices, the mortality rate for patients with cardiogenic shock remains high. This study aimed to evaluate the efficacy of early intra-aortic balloon pump (IABP) support compared to medical therapy in patients with cardiogenic shock (CS) due to acute myocardial infarction (AMI) (AMI-CS) resulting in severe left ventricular (LV) systolic dysfunction.

Methods

We analyzed the RESCUE I registry (NCT02985008), a multicenter cohort of 1247 cardiogenic shock patients. A total of 192 patients with AMI-CS with LVEF ≤ 35% received either medical therapy (n = 105) or IABP support (n = 87) after shock development. The primary outcome was in-hospital mortality. Then, we compared mortality in early IABP initiation (shock-to-IABP < 2 h) to medical therapy.

Results

The overall in-hospital mortality rate was 42.2%. While the difference in mortality rates between the medical therapy group and the IABP group was not statistically significant (47.6% vs. 35.6%, respectively, p = 0.094), a reduction in mortality was observed when IABP support was initiated within 2 h of shock onset (32.0% vs. 47.6%, p = 0.036). Furthermore, the need for advanced MCS was reduced in the IABP group compared to the medical group (4.6% vs. 22.9%, respectively, p < 0.001).

Conclusions

In patients with AMI-CS and severe LV dysfunction, early IABP support initiated within 2 h of shock onset was associated with lower in-hospital mortality and reduced need for advanced MCS. These findings highlight the critical importance of timing rather than routine use, supporting a selective strategy for early IABP.