Intra-aortic balloon pump in cardiogenic shock: predictors of mortality and role in contemporary practice at a tertiary center (2011-2024)

Introduction The role of the intra-aortic balloon pump (IABP) in cardiogenic shock (CS) remains controversial following recent clinical trials. Nevertheless, due to its physiological benefits, it continues to be used in selected patients, particularly those with ischemic etiologies. Objective To analyze the characteristics, management, and outcomes of patients admitted with CS in a tertiary hospital, comparing those who received IABP versus those who did not, and to identify predictors of in-hospital mortality among IABP-treated patients. Methods A retrospective analysis was conducted on patients admitted with CS between 2011 and 2024 (n=759). Baseline characteristics, laboratory data, therapeutic interventions, and clinical outcomes were compared between patients who received IABP (n=106) and those who did not (n=653). Within the IABP group, survivors and non-survivors were compared to identify variables associated with in-hospital mortality, and a multivariable logistic regression model was developed to determine independent predictors. Results Overall in-hospital mortality was 42.8%, with 50% in IABP-treated patients and 41.7% in those without (p=0.12). Men predominated in both groups, with a higher proportion in the IABP group (76.4% vs 64.9%; p=0.002). IABP patients were younger (66±12 vs 72±12 years; p=0.0002) and more frequently presented with ST-elevation myocardial infarction (p=0.02). No significant differences were found in baseline characteristics or laboratory values except for a higher prevalence of previous ischemic heart disease in the IABP group (64.2% vs 51.9%; p=0.02). The IABP group showed greater hemodynamic compromise, reflected by more frequent use of dobutamine (100% vs 80.7%; p<0.001), norepinephrine (97.2% vs 79.9%; p<0.001), orotracheal intubation (67.9% vs 33.5%; p<0.001), and renal replacement therapy (15.1% vs 7.5%; p=0.01). Among IABP-treated patients, non-survivors (n=53) were older (69.2±10.4 vs 64.3±13.2 years; p=0.03), had lower glomerular filtration rate (47.9±18.2 vs 64.1±26.8; p=0.0003), and more frequently required orotracheal intubation (82.9% vs 57.8%; p=0.01) and renal replacement therapy (19.5% vs 10.9%; p=0.34). In multivariable analysis, older age, renal dysfunction, and the need for mechanical ventilation remained independently associated with in-hospital mortality (Table 2). Conclusions IABP was mainly used in younger patients with ischemic cardiogenic shock and greater hemodynamic compromise. In this subgroup, in-hospital mortality was primarily related to older age, renal impairment, and need for advanced respiratory or renal support. Appropriate patient selection and baseline organ reserve remain key determinants of outcomes in IABP-treated cardiogenic shock. The higher mortality observed among IABP patients likely reflects greater baseline severity rather than an adverse effect of the device itself.