Intra-Aortic Balloon Pump Support in Patients with Acute Myocardial Infarction with Ventricular Septal Rupture

Abstract

Background: An intra-aortic balloon pump (IABP) is the device most frequently used as a bridge to surgical repair in cases of myocardial infarction. However, robust evidence of IABP support for patients with postinfarction ventricular septal rupture (VSR) remains lacking. This study was aimed at assessing the effect of IABP support on 30-day prognosis in patients with acute myocardial infarction (AMI) complicated by VSR. Methods: Retrospective data for patients with VSR after AMI at Fuwai Hospital between April 2002 and August 2020 were analyzed. Patients were initially stratified into two groups according to IABP implantation. The Kaplan-Meier method was used to determine the cumulative incidence of 30-day all-cause mortality. Multivariate logistic regression was used to evaluate the independent risk factors for 30-day mortality. Results: A total of 92 patients (mean age of 67.8 ± 8.3 years; 46.7% male) were included, 59 of whom underwent IABP implantation. Patients with rather than without IABP treatment were younger, were more often male, and had a higher body mass index and lower mean blood pressure at the onset of VSR. At 30 days, all-cause death occurred in 21 patients in the IABP group (35.59%) and 31 patients in the group without IABP (93.94%). After adjustment for age, sex, left atrial diameter, left ventricular diameter, perforation diameter and ventricular aneurysm, IABP support was found to be an independent protective predictor of 30-day all-cause mortality (hazard ratio: 0.22; 95% confidence interval: 0.12 to 0.42; P < 0.001). Conclusions: IABP support was associated with lower 30-day mortality in patients with VSR after AMI. Patients with postinfarction VSR with hemodynamic instability or cardiogenic shock could receive IABP treatment as a bridge to surgical repair.