74 Intra-aortic balloon pump insertion in the management of post-MI cardiogenic shock
2021
Introduction Cardiogenic shock is a complication of acute myocardial infarction (MI) that occurs in 7-8% of patients. It is the leading cause of death post-MI, with an estimated in-patient mortality of 50%. Historically, intra-aortic balloon pump (IABP) insertion has been widely used with the aim of improving cardiac output and hence reducing mortality. However, the large, randomized controlled ‘IABP shock-II’ trial found no significant improvement in 30-day, 1-year or 6-year outcomes, including all-cause mortality. International guidelines have downgraded the IABP from a class I to class IIIa and it is therefore no longer recommended.In this study, we assess the frequency of IABP insertion for cardiogenic shock following updated international guidelines. Methods All cases that presented with acute myocardial infarction at Queen Elizabeth Hospital between January 2018 and December 2019 (n=59) were retrospectively reviewed.There were 1904 cases and 59 had cardiogenic shock. We compared baseline characteristics, complications and mortality between cardiogenic shock patients with and without IABP insertion. Results 19 of the 59 patients with cardiogenic shock had IABP insertion (73.7% Male, mean age 65.6± 11.3 year). Diabetes, hypertension and previous myocardial infarction were identified in 36.8%,36.8% and 42.1% respectively. 47.4% were ventilated at the time of the procedure, with a mean pH of 7.16 and mean lactate of 8.1mmol/L. STEMI was present in 84.2% of the patients, and the type C lesion was the most common finding on the angiogram (68.4%).On the other hand, 34 patients with cardiogenic shock did not receive IABP (70.6% Male, mean age 68.9± 11 year). Diabetes, hypertension and previous myocardial infarction were identified in 25.5%,47% and 20.6% respectively. 44.1% were ventilated at the time of the procedure, with mean pH of 7.19 and mean lactate of 6.6 mmol/L. STEMI was presented in 82.4% of the patients, and the type C lesion was the most common finding on the angiogram (58.8%). Table 1. The in-hospital mortality of the IABP group was 68.4% and 41.2% in the non-IABP group. Kaplan-Meier curve showed that the 30-day mortality probability was 68.4% for the IABP group, and 44.1% for the non-IABP group. Figure 1. 11 of the 19 patients with IABP insertion had complications related to the device. Conclusions Our small study shows that IABP support does not result in reduced in-hospital mortality in patients presenting with cardiogenic shock. Morality remains high despite advance in medical treatment. Conflict of Interest Cardiology
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