Renal and Cardiovascular Outcomes of IABP-Assisted PCI in Renal Dysfunction: A Propensity-Matched Study and MACEs Prediction Model Development

The renal safety and cardiovascular outcomes of intra-aortic balloon pump (IABP) support during percutaneous coronary intervention (PCI) in patients with renal dysfunction remain controversial. To investigate the effects of IABP on renal function and major adverse cardiovascular events (MACEs) in PCI patients with renal dysfunction, and to establish an individualized prognostic prediction model. In this retrospective cohort study, 253 PCI patients with renal dysfunction from Meizhou People's Hospital (January-December 2023) were analyzed. Propensity score matching (1:4 IABP/non-IABP) balanced baseline characteristics. Least absolute shrinkage and selection operator (LASSO) regression identified predictors for MACEs, followed by nomogram development and validation. Post-matching (IABP = 16, non-IABP = 64), despite higher baseline risk in the IABP group, no intergroup differences occurred in postoperative creatinine, eGFR, or MACEs incidence (all P >0.05). However, this group exhibited greater eGFR decline from baseline. Multivariate analysis identified five independent MACEs predictors: preoperative B-type natriuretic peptide (BNP), postoperative BNP, preoperative neutrophil-to-lymphocyte ratio (NLR), postoperative blood urea nitrogen (BUN), and prealbumin levels. The prediction model achieved AUCs of 0.869 (95% CI: 0.774-0.964) and 0.843 (95% CI: 0.678-1.000) in training and validation sets, with decision curve analysis confirming clinical utility at 10%-80% risk thresholds. IABP may exacerbate subclinical renal injury in PCI patients with renal dysfunction without mitigating MACEs risk. The validated nomogram provides individualized risk stratification to guide clinical management.