Evidence of the Advantages of Preoperative Intra-aortic Balloon Pump in Surgical Revascularization of Acute Myocardial Infarction

Background: Early coronary artery bypass grafting (CABG) in patients with acute myocardial infarction (AMI) is associated with considerable risk. The optimal timing of surgery and the preoperative use of an intra-aortic balloon pump (IABP) in these patients remain unclear. Methods: To asses the effect of preoperative IABP on troponin levels, surgical timing, and postoperative outcomes, 230 AMI patients scheduled for CABG were divided into two groups: Group A received support with IABP, whereas Group B served as the control group without IABP. The analysis evaluated the preoperative reduction in high-sensitivity cardiac troponin I (hsCTI) levels, timing of surgery, durations of intensive care unit (ICU) and hospital stays (HS), and mortality rates. Results: After propensity score matching, Group A comprised 64 patients with a mean age of 63.1 ± 8.9 years, and Group B comprised 92 patients with a mean age of 65.2 ± 8.1 years. In the IABP group, participants exhibited relief from angina symptoms, faster reduction in hsCTI levels, improved transit-time flow measurement (TTFM) of grafts, and shorter ICU and HS durations. The overall mortality rate was 7.1%. However, preoperative IABP support reduced the mortality rate by a factor of 0.6 compared to intraoperative IABP (β = –0.86; Z = –2.41; OR = 0.42, 95% CI: 0.2–0.85; p = 0.016). Conclusions: The IABP provides myocardial preconditioning in patients with AMI, thus preparing the myocardium for CABG. Its use should be considered, particularly for high-risk patients. This study has obtained a clinical registration number (NCT number: NCT06468982).