Prophylactic IABP Use in Protected PCI Reduces Infarction Size and Leads to More Complete Revascularization in Comparison to Rescue IAPB Use

Background There is little data questioning the timing of intra‐aortic balloon pump (IABP) implantation in non‐cardiogenic shock patients undergoing high‐risk percutaneous procedures. Aims We compared prophylactic IABP (P‐IABP) implantation to an emergent, unplanned rescue use (R‐IABP) in high‐risk PCI. Methods Among 300 IAPB patients who were treated at Ulm University Heart Center, Germany, between 2012 and 2020, we retrospectively selected and analyzed data from 59 patients. The cohort was subdivided into 44 P‐IABP and 15 R‐IAPB patients who underwent protected PCI with an IABP. Patients with cardiogenic shock at baseline, Impella‐pump or extra corporal membrane oxygenator (ECMO) were excluded. Both elective and emergency patients with acute coronary syndrome were included. Results Both groups showed no significant difference in the baseline characteristics. The achieved SYNTAX score reduction after PCI (delta SYNTAX) was higher in the P‐IABP group (22.15 ± 10.31 points in the P‐IAPB and 15.73 ± 10.13 points in the R‐IABP group, p = 0.04). In addition, we observed lower highly sensitive Troponin T (hsTnT) peak values in the P‐IAPB group after the intervention (2223.33 ± 3129.77 ng/L vs. 5823.85 ± 3885.35 ng/L, p = 0.001). P‐IABP was associated with peak hsTnT values ( p = 0.01). The 30‐day mortality rates were not significantly different ( p = 0.88). Conclusion Patients in the prophylactic‐IAPB group experienced a more complete revascularization measured with the delta SYNTAX score compared to those in the rescue‐IAPB group. Moreover, peri‐interventional infarct size measured by hsTnT release was significantly lower. Both findings indicate that P‐IABP implantation in high‐risk PCI should be preferred to rescue IAPB use.