Outcomes of STEMI Complicated by Cardiogenic Shock With and Without IABP

The results of the IABP-SHOCK II trial did not encourage the use of an intra-aortic balloon pump (IABP) in cardiogenic shock (CS) with ST-elevation myocardial infarction (STEMI). We aimed to determine whether these findings may be applicable to our population in the South Asian region, as there is a paucity of data.

In this prospective cohort study, 2 independent cohorts of STEMI patients with CS were recruited based on the utilization of IABP during revascularization. The primary endpoints of in-hospital and after 30 days of major adverse cardiac events (MACE) and the secondary endpoint of any major bleed were compared between the 2 cohorts.

In total, each cohort consisted of 130 patients. Demographic, clinical, and angiographic profiles were comparable in the 2 cohorts. In the IABP and non-IABP cohorts, the in-hospital and 30-day mortality rates were 19.2% vs 26.2%; P=0.183 and 30.8% vs 36.9%; P=0.358, respectively, while the MACE rates were 20.8% vs 26.2%; P=0.306 and 32.3% vs 36.9%; P=0.434, respectively. Cardiac catheterization laboratory death was 0.8% vs 5.4%; P=0.031 and the major bleed was 4.6% vs 3.8%; P=0.758, among patients managed with IABP and without IABP, respectively.

Our study concluded that while there was no significant difference in the overall outcome, there was a lower trend in in-hospital mortality and significantly lower cardiac catheterization laboratory death with the use of IABP. However, the in-hospital and 30-day MACE were comparable in both groups.