Key result
IABP in AMI-CS linked to ~35% lower inpatient mortality versus medical management alone.
Why the study?
AMI-CS carries the highest in-hospital mortality among acute coronary syndromes, and the impact of widely used IABP therapy compared with non-IABP medical management on mortality and clinical outcomes required evaluation.
Does intra-aortic balloon pump reduce inpatient mortality in patients with acute myocardial infarction complicated by cardiogenic shock compared to medical management alone?
Cohort (n=247,825)
Yes
Does intra-aortic balloon pump reduce inpatient mortality in patients with acute myocardial infarction complicated by cardiogenic shock compared to medical management alone?
Effect estimate: aOR 0.653 (95% CI 0.623-0.684)
p-value: p=<0.001
In a large retrospective cohort of AMI-CS patients, IABP use was associated with significantly lower inpatient mortality but higher rates of thrombocytopenia and mechanical complications compared to medical management alone.
IABP use was associated with lower inpatient mortality; leaves open causal benefit versus selection bias in this observational cohort.
BACKGROUND: Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) carries the highest in-hospital mortality among acute coronary syndromes, with medical management and various adjunctive therapies employed to care for these critically-ill patients. OBJECTIVE: Intra-aortic balloon pumps (IABP) are a widely-used therapy, thus we aim to evaluate differences in mortality, clinical outcomes, and hospital courses of patients with AMI-CS treated with IABP versus non-IABP medical management. METHODS: We conducted a retrospective cohort study of the National Inpatient Sample database between October 2015 and December 2022, including patients ≥18 years-old hospitalized with AMI and subsequent CS. Propensity score-based inverse probability of treatment weighting and multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs). RESULTS: Among 247,825 AMI-CS hospitalizations, 84,635 (34.2%) involved IABP. IABP was associated with lower odds of both routine discharge (aOR: 0.837, 95% CI [0.794-0.882], p < 0.001) and inpatient mortality (0.653[0.623-0.684], p < 0.001), increased thrombocytopenia (2.10[1.98-2.22], p < 0.001) and lower acute kidney injury (0.816[0.783-0.849], p < 0.001). These patients also had higher odds of papillary muscle rupture (3.58[2.50-5.12], p < 0.001) and left ventricular wall rupture (1.67[1.17-2.39], p = 0.005). CONCLUSIONS: Despite greater baseline sickness, IABP was linked with a significant inpatient mortality reduction in AMI-CS. Increased thrombocytopenia and non-routine discharge potentially reflect treatment-related morbidity as a result of survivorship bias compared to patients receiving medical management alone. Prospective studies are needed to refine patient selection and mitigate device-related complications.
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Malhotra et al. (2026) conducted a cohort in Acute myocardial infarction complicated by cardiogenic shock (n=247,825). Intra-aortic balloon pump (IABP) vs. Non-IABP medical management was evaluated on Inpatient mortality (aOR 0.653, 95% CI 0.623-0.684, p=<0.001). Intra-aortic balloon pump use in AMI-CS was associated with significantly lower inpatient mortality compared to medical management alone (aOR 0.653; 95% CI 0.623-0.684; p < 0.001).
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