Intra-aortic Balloon Pump Trials

Clinical experience with the intra-aortic balloon pump (IABP) spans >40 years.1 Physiological studies have demonstrated that the IABP acutely improves systemic hemodynamics, augments coronary flow, reduces myocardial oxygen demand, and can sustain coronary patency after percutaneous revascularization.2–4 These sound physiological principles, largely supportive observational data,5–7 and a historical lack of alternative percutaneous devices to provide circulatory support led to the widespread use of the IABP in cardiogenic shock secondary to acute myocardial infarction (AMI), ST-segment elevation-acute coronary syndrome without shock and also in high-risk percutaneous coronary intervention (PCI), despite a paucity of adequately powered randomized evidence to support their use. Nearly 5 decades since the introduction of IABP into clinical practice, we finally have randomized data on the efficacy of balloon counterpulsation for each of the 3 above indications.8–10 The main clinical applications for counterpulsation and the randomized data for each indication are summarized in the Table.