Key result
Pre-PCI IABP linked to ~56% lower 30-day mortality vs post-PCI in STEMI cardiogenic shock.
Why the study?
PCI in STEMI with high-grade thrombus carries poor outcomes, and data on whether IABP support improves coronary hemodynamics and clinical outcomes in this setting are sparse.
Does pre-PCI initiation of an intra-aortic balloon pump (IABP) reduce 30-day mortality compared to post-PCI initiation in patients with STEMI, high thrombus burden, and cardiogenic shock?
Observational (n=30)
No
Does pre-PCI initiation of an intra-aortic balloon pump (IABP) reduce 30-day mortality compared to post-PCI initiation in patients with STEMI, high thrombus burden, and cardiogenic shock?
Effect estimate: RR 0.44 (95% CI 0.22-0.86)
Absolute Event Rate: 35% vs 80%
p-value: p=0.020
Initiation of an intra-aortic balloon pump before PCI significantly reduces 30-day mortality compared to post-PCI initiation in patients with STEMI complicated by cardiogenic shock and high thrombus burden.
May support pre-PCI IABP in this high-risk cohort; hypothesis-generating and requires RCTs before practice change.
BACKGROUND: Percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) with high-grade thrombus is a high-risk intervention associated with poor clinical outcomes. Circulatory support with an intra-aortic balloon pump (IABP) during PCI may potentially improve coronary hemodynamics and clinical outcomes in such patients. As existing data on this situation are sparse, we did an observational study to determine short-term outcomes of PCI with IABP support in STEMI patients with high thrombus burden. OBJECTIVES: To determine whether IABP has a potential role in improving outcomes in patients with STEMI with high thrombus burden who are undergoing PCI. METHODS AND RESULTS: Thirty consecutive patients of STEMI with high thrombus burden undergoing PCI with IABP assistance were included. Ninety-three percent of patients had a cardiogenic shock. Clinical and angiographic outcomes assessed include a change in left ventricular ejection fraction (LVEF), 30-day mortality, and assessment of TIMI (thrombolysis in myocardial infarction) flow, TIMI frame count, and TIMI myocardial perfusion grade in the culprit vessel. IABP was initiated before coronary angiography in 36.6% (n=11), between angiography and PCI in 30% (n=9), and after PCI in 33.3% (n=10) of patients. During the 30-day follow-up period, 50% (n=15) of patients died. 86.6% (n=13) of survivors had pre-PCI IABP initiation compared to only 46.6% (n=7) among those who died (p=0.020). With pre-PCI IABP initiation (n=20), 30-day mortality was 35% (n=7) compared to 80% (n=8) with post-PCI IABP initiation (n=10) (p=0.020). CONCLUSION: IABP initiation before PCI in STEMI complicated by cardiogenic shock and high angiographic thrombus burden can decrease mortality without any effect on angiographic parameters.
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Chauhan et al. (2023) conducted an observational in ST-elevation myocardial infarction (STEMI) with high thrombus burden and cardiogenic shock (n=30). Pre-PCI IABP initiation vs. Post-PCI IABP initiation was evaluated on 30-day all-cause mortality (RR 0.44, 95% CI 0.22-0.86, p=0.020). Pre-PCI initiation of an intra-aortic balloon pump reduced 30-day mortality to 35% compared to 80% with post-PCI initiation (RR 0.44) in STEMI patients with high thrombus burden and cardiogenic shock.
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