Intra‐Aortic Balloon Pump Use in Acute Coronary Syndrome Without Cardiogenic Shock: Association With Mortality in the CCC‐ACS Cohort

BACKGROUND: The role of intra-aortic balloon pump (IABP) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) without cardiogenic shock remains controversial. AIMS: To assess the association between IABP use and in-hospital mortality in this population and to identify high-risk subgroups. METHODS: This multicenter retrospective study analyzed data from the CCC-ACS Project. Propensity score matching (PSM) and multivariable logistic regression were performed to adjust for confounders. Subgroup analyses identified patients groups at greater risk. A supplementary meta-analysis was conducted to reflect existing uncertainty in the broader literature. RESULTS: Among 32,863 ACS patients, 1,127 (3.4%) received IABP. In the propensity-matched cohort, IABP use was associated with higher in-hospital mortality (adjusted OR: 2.56, 95% CI: 1.30-5.04, p = 0.006). The risk was more pronounced in patients with ST-segment elevation myocardial infarction, heart failure, reduced left ventricular ejection fraction, and renal impairment. The meta-analysis of 10 studies showed no significant association between IABP use and mortality (RR = 1.06, 95% CI: 0.79-1.42, p = 0.70). CONCLUSIONS: IABP use in ACS patients without cardiogenic shock was associated with increased in-hospital mortality, particularly among high-risk subgroups. Careful patient selection is warranted, and further research is needed to refine its clinical indications.