Background: Conflicting results exist whether initiation of intraaortic balloon pumping (IABP) before primary percutaneous coronary intervention (PPCI) in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) may have an impact on outcome. Methods: The IABP-SHOCK II-trial randomized 600 patients with AMI and CS to IABP-support vs. control. We analyzed patients randomized to the intervention group regarding the timing of IABP implantation pre or post PPCI in a post-hoc analysis and its impact on outcome. Results: In total 600 patients were included in the IABP-SHOCK II trial. Of these 301 were randomized to IABP-support. We analyzed the 275 (91%) patients of this group with PPCI as revascularization strategy and an implanted IABP surviving the initial procedure. The implantation was performed pre PPCI in 33 (12%) and post PPCI in 242 (88%) patients. There were no differences in baseline serum lactate (p=0.70), Simplified Acute Physiology Score-II-score (p=0.60) and other important baseline characteristics such as age (p=0.69) and severity of coronary artery disease (p=0.99). No differences were observed for short- and long-term mortality (pre vs. post 30-day mortality: 36 vs. 36%, p=0.99; 1-year mortality: 52 vs. 48%, p=0.73). In multivariable Cox regression analysis adjusted for age, gender, need for invasive ventilation, prior stroke, peripheral artery disease, hypertension, diabetes, prior medication, kidney function, hemoglobin values, ECG findings, extent of coronary artery disease, serum lactate and TIMI-flow grades prior and post PPCI timing of IABP-implantation remained no significant predictor of long-term outcome (HR 1.24 [95%CI 0.74-2.10]; p=0.41). Conclusions: Timing of IABP-implantation pre or post PPCI had no impact on outcome in patients with AMI complicated by CS.
Fuernau, G., Ledwoch, J., Eitel, I., de Waha, S., Desch, S., Werdan, K., … Thiele, H. (2017). IMPACT OF TIMING OF INTRA-AORTIC BALLOON COUNTERPULSATION ON MORTALITY IN CARDIOGENIC SHOCK: A SUB-ANALYSIS OF THE IABP-SHOCK II-TRIAL. Journal of the American College of Cardiology, 69(11), 1182. https://doi.org/10.1016/s0735-1097(17)34571-0