Intra-Aortic Balloon Pump During High-Risk PCI

High-risk percutaneous coronary intervention (PCI) is associated with elevated morbidity and mortality, particularly in patients with complex coronary anatomy and left ventricular (LV) dysfunction. Intra-aortic balloon pump (IABP) support is often used to maintain hemodynamic stability during these procedures. This case series assesses outcomes and predictors of mortality in patients undergoing high-risk PCI with IABP support. This single-center observational study included 30 patients who underwent high-risk PCI with elective or emergent IABP support. Baseline clinical and procedural data were collected. Primary outcomes were procedural success, LV recovery, and in-hospital mortality. Multivariate logistic regression identified predictors of mortality. The mean age was 62 ± 10 years, with 66.7% male. The average ejection fraction was 34.3%, and 53.3% had a SYNTAX score >33. Cardiogenic shock was present in 46.7%. Procedural success was achieved in 73.3%, and LV recovery in 60%. The 30-day mortality rate was 30%. Cardiogenic shock (odds ratio = 5.2, P = 0.004) and high SYNTAX score (odds ratio = 4.6, P = 0.008) were independent predictors of mortality. Despite IABP support, patients undergoing high-risk PCI remain at significant risk, particularly those with cardiogenic shock and complex coronary disease. Improved patient selection and alternative support strategies may enhance outcomes.