Analysis of results from intra-aortic balloon pump counterpulsation in patients with myocardial infarction and cardiogenic shock

Aim. To build a clinical and instrumental profile of patients with myocardial infarction (MI) complicated by the development of cardiogenic shock (CS) who underwent intra-aortic balloon pump (IABP) counterpulsation and evaluate the results of this treatment.

Material and Methods. The single-center observational registry study comprised patients with admitting diagnosis of MI complicated by CS who were admitted to Cardiology Research Institute of Tomsk NIMC from 01.01.2020 to 12.31.2021. All patients received emergency IABP at admission, and reperfusion of infarct-related artery was achieved. According to these criteria, a total of 23 patients were included in the analysis.

Results. The average age of patients was 79 years. There were comparable numbers of men and women in study group. Vast majority of patients (78.2%) had postinfarction cardiosclerosis; 86.9% of patients had hypertension; third of patients had diabetes mellitus; and almost half of patients were obese. Most of these patients (73.9%) had MI with ST segment elevation; the rest of patients had MI without ST segment elevation. 60.9% of patients had anterior wall MI, and the rest of patients had inferior wall MI. The pain-to-door time was 223 minutes on average. Thrombolysis was performed in 9 cases (39%) at the prehospital stage with an efficiency of 55%. The majority of patients (n = 22) underwent coronary stenting of infarct-related artery. The duration of IABP was 52.5 hours an average, and the mortality rate was 69.5%. All fatal outcomes occurred as a result of CS progression. There were no statistically significant differences in the main clinical and anamnestic characteristics between the groups with the administration of IABP before and after PCI, although the patients in the group of IABP before PCI were younger, had a lower level of troponin at admission, more often achieved coronary reperfusion TIMI-2-3 at PCI, and had lower mortality.

Conclusion. The frequency of IABP administration to patients with MI and CS in our department was 8%. The mortality rate among patients who underwent IABP insertion reached 69.5%, which was not lower than the corresponding rate in the general group of CS (55%). The combination of IABP installation before PCI in the presence of achieved coronary reperfusion (spontaneous or due to thrombolysis) was associated with a tendency to decrease in mortality compared with the installation of IABP after PCI.

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