Early Intra-Aortic Balloon Pump Support and In-Hospital Mortality in Patients with LV Dysfunction and Cardiogenic Shock Complicating AMI

Background: Despite advancements in mechanical support (MCS) devices, the mortality rate for patients with cardiogenic shock remains high. This study aimed to evaluate the efficacy of early intra-aortic balloon pump (IABP) support compared to medical therapy in patients with cardiogenic shock (CS) due to acute myocardial infarction (AMI) (AMI-CS) resulting in severe left ventricular (LV) systolic dysfunction. Methods: We analyzed the RESCUE I registry (NCT02985008), a multicenter cohort of 1247 cardiogenic shock patients. A total of 192 patients with AMI-CS with LVEF ≤ 35% received either medical therapy (n = 105) or IABP support (n = 87) after shock development. The primary outcome was in-hospital mortality. Then, we compared mortality in early IABP initiation (shock-to-IABP < 2 h) to medical therapy. Results: The overall in-hospital mortality rate was 42.2%. While the difference in mortality rates between the medical therapy group and the IABP group was not statistically significant (47.6% vs. 35.6%, respectively, p = 0.094), a reduction in mortality was observed when IABP support was initiated within 2 h of shock onset (32.0% vs. 47.6%, p = 0.036). Furthermore, the need for advanced MCS was reduced in the IABP group compared to the medical group (4.6% vs. 22.9%, respectively, p < 0.001). Conclusions: In patients with AMI-CS and severe LV dysfunction, early IABP support initiated within 2 h of shock onset was associated with lower in-hospital mortality and reduced need for advanced MCS. These findings highlight the critical importance of timing rather than routine use, supporting a selective strategy for early IABP.