Key result
Early IABP fails to improve 60-day survival or bridging vs standard care.
Why the study?
The impact of intra-aortic balloon pump on survival and successful bridging to heart replacement therapies in patients with heart failure-cardiogenic shock remains unclear.
Does early IABP plus standard care improve survival or successful bridging to HRT at 60 days in patients with HF-CS?
RCT (n=101)
randomized
Yes
Does early IABP plus standard care improve survival or successful bridging to HRT at 60 days in patients with HF-CS?
Answers are grounded in this paper and cite their sources.
Routine early IABP plus standard care did not significantly improve 60-day survival or successful bridging to heart replacement therapies in patients with heart failure-related cardiogenic shock compared to standard care alone.
BACKGROUND: The impact of intra-aortic balloon pump (IABP) on survival and successful bridging to heart replacement therapies (HRT) in patients with heart failure-cardiogenic shock (HF-CS) remains unclear. OBJECTIVES: The purpose of this study was to evaluate the effect of early IABP use vs standard care on 60-day survival or successful bridging to HRT. METHODS: In the multicenter, prospective Altshock-2 (Study on Early Intra-aortic Balloon Pump Placement in Acute Decompensated Heart Failure Complicated by Cardiogenic Shock), patients with Society for Cardiovascular Angiography and Interventions stage B, C, or D HF-CS and suitable for HRT were randomized to receive early IABP plus standard care (IABP group) or standard care (control group). The primary endpoint was survival or successful bridge to HRT at 60 days. Secondary endpoints included overall survival, maximum inotropic score, and maximum sequential organ failure assessment score. RESULTS: In total, 53 patients were randomized to IABP and 48 to standard care. Patients were Society for Cardiovascular Angiography and Interventions stage B (28%, n = 28), C (57%, n = 56), and D (15%, n = 16). At the prespecified interim analysis, the trial was stopped because of futility. The primary endpoint was reached in 43 patients (81%) in the IABP group and 36 patients (75%) in the control group (HR: 0.72; 95% CI: 0.31-1.68; P = 0.45). A total of 37 patients (37%) underwent HRT within the 60-day follow-up. Four patients were escalated in the study group (7.5%) vs 2 in the control group (4.2%). Additionally, 6 patients (13%) initially assigned to standard care crossed over to IABP. Complications were comparable between groups. CONCLUSIONS: Routine early IABP plus standard care, compared with standard care, did not significantly improve survival or successful bridging to HRT in patients with HF-CS. (Study on Early Intra-aortic Balloon Pump Placement in Acute Decompensated Heart Failure Complicated by Cardiogenic Shock [Altshock-2]; NCT04369573).
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Morici et al. (2025) conducted an RCT in Heart failure-cardiogenic shock (HF-CS) (n=101). Early intra-aortic balloon pump (IABP) vs. Standard care was evaluated on Survival or successful bridge to heart replacement therapies at 60 days (HR 0.72, 95% CI 0.31-1.68, p=0.45). Early intra-aortic balloon pump use did not significantly improve 60-day survival or successful bridging to heart replacement therapies compared with standard care (81% vs 75%; HR 0.72; P=0.45).
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