1. Nonroutine Use of Intra-Aortic Balloon Pump in Cardiogenic Shock Complicating Myocardial Infarction With Successful and Unsuccessful Primary Percutaneous Coronary Intervention.
- Author
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Hawranek M, Gierlotka M, Pres D, Zembala M, and Gąsior M
- Subjects
- Humans, Non-ST Elevated Myocardial Infarction diagnosis, Non-ST Elevated Myocardial Infarction mortality, Non-ST Elevated Myocardial Infarction physiopathology, Poland, Prospective Studies, Recovery of Function, Registries, Risk Factors, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction mortality, ST Elevation Myocardial Infarction physiopathology, Shock, Cardiogenic diagnosis, Shock, Cardiogenic mortality, Shock, Cardiogenic physiopathology, Time Factors, Treatment Outcome, Intra-Aortic Balloon Pumping adverse effects, Intra-Aortic Balloon Pumping mortality, Non-ST Elevated Myocardial Infarction therapy, Percutaneous Coronary Intervention adverse effects, Percutaneous Coronary Intervention mortality, ST Elevation Myocardial Infarction therapy, Shock, Cardiogenic therapy
- Abstract
Objectives: The authors sought to compare outcomes of patients with myocardial infarction and cardiogenic shock (CS) treated with percutaneous coronary intervention (PCI) with or without intra-aortic balloon pump (IABP) support according to final epicardial flow in the infarct-related artery., Background: A routine use of IABP is contraindicated in patients with myocardial infarction and CS. There are no data regarding the subpopulation of patients who may benefit from such support besides patients with mechanical complications of myocardial infarction., Methods: Prospective nationwide registry data of patients with myocardial infarction and CS treated with PCI between 2003 and 2014 were analyzed. Patients were initially stratified into 2 groups according to final infarct-related artery Thrombolysis In Myocardial Infarction (TIMI) flow grade after PCI: those with successful primary PCI (TIMI flow grades 2 or 3) and those with unsuccessful primary PCI (TIMI flow grades 0 or 1). Outcomes of patients with or without IABP treatment in each group were analyzed and compared., Results: In the unsuccessful PCI group, patients in whom IABP was applied had lower in-hospital, 30-day, and 12-month mortality. IABP support in this group of patients was an independent predictor of lower 30-day mortality (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.59 to 0.89; p = 0.002). Conversely, in patients with successful PCI, IABP was an independent predictor of higher 30-day mortality (HR: 1.18; 95% CI: 1.08 to 1.30; p = 0.0004)., Conclusions: IABP is associated with a lower risk of 30-day mortality in patients with myocardial infarction complicated by CS, in whom primary PCI was unsuccessful., (Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
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