The intra-aortic balloon pump lacks confirmed clinical benefit in cardiogenic shock after acute MI, though pre-procedural implantation may improve long-term outcomes in high-risk PCI.
This review emphasizes the need to re-evaluate traditional IABP indications, noting a lack of benefit in post-AMI cardiogenic shock but potential utility in high-risk PCI and as a bridge to advanced heart failure therapies.
PURPOSE OF REVIEW: The intra-aortic balloon pump (IABP) has been used for more than 40 years. Although recommended in a wide variety of clinical settings, most of these indications are not evidence-based. This review focuses on studies challenging these traditional indications and evaluates potentially new applications of intra-aortic counterpulsation. RECENT FINDINGS: Recent studies have failed to confirm an improvement in clinical outcomes conferred by the IABP in patients developing cardiogenic shock after acute myocardial infarction. This issue is in need of further investigations. While conflicting results of several retrospective studies and meta-analyses have been published regarding the performance of the IABP in high-risk percutaneous coronary interventions, it has recently been found to improve the long-term clinical outcomes of patients in whom it was implanted before the procedure. Small, single-center studies have reported the use of the IABP as a bridge to transplantation or candidacy for left-ventricular assist device implantation. The recently reported feasibility and safety of its insertion via the subclavian or axillary arteries will facilitate these applications. SUMMARY: The revisiting of available data and the performance of new, thoughtfully designed trials should clarify the proper indications for the IABP.
Kapelios et al. (Mon,) conducted a review in Cardiogenic shock after acute myocardial infarction, high-risk PCI. Intra-aortic balloon pump (IABP) was evaluated. The intra-aortic balloon pump lacks confirmed clinical benefit in cardiogenic shock after acute MI, though pre-procedural implantation may improve long-term outcomes in high-risk PCI.