The use of an intra-aortic balloon pump in patients with cardiogenic shock secondary to acute myocardial infarction

Abstract Background Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with high mortality despite advances in therapy. The intra-aortic balloon pump (IABP) is used to support hemodynamics in these patients, but its efficacy remains debated. This study aimed to evaluate the outcomes of IABP use in patients with AMI complicated by CS. Results This retrospective cohort study included 95 patients with AMI-CS treated at a tertiary referral center from January 2020 to December 2022. Patients were divided into two groups: those receiving IABP ( n = 72) and those not receiving IABP ( n = 23). Baseline characteristics revealed that patients who received IABP had more advanced shock [SCAI stage E 25% vs. 9%, P < 0.01], an increased prevalence of cardiac arrest at presentation [31% vs. 4%, P = 0.01], and required more aggressive hospital interventions, including vasopressor support [97% vs. 39%, P < 0.01], mechanical ventilation [90% vs. 30%, P < 0.01], and renal replacement therapy [42% vs. 9%, P < 0.01]. The IABP group had significantly higher in-hospital mortality [69% vs. 30%, P < 0.01]. IABP was associated with increased in-hospital mortality in patients with cardiac arrest [OR 27, P < 0.01], but in patients without cardiac arrest, IABP use reduced mortality [OR 0.15, P = 0.02]. There were no significant differences in cerebrovascular accident, bleeding, and length of stay between groups. No significant differences in long-term survival were observed between the groups [log-rank P = 0.44]. Conclusions IABP use in AMI-CS patients was associated with higher in-hospital mortality, reflected by the more critical clinical status of these patients at baseline. IABP may offer in-hospital survival benefits in patients without cardiac arrest but does not improve long-term outcomes. Further research is needed to refine its role in clinical practice.