Impact of intra-aortic balloon pumping on hypotension and outcomes in acute right ventricular infarction

OBJECTIVES: This study investigated the immediate hemodynamic effects of intra-aortic balloon pump (IABP) support and clinical outcomes in patients with acute right ventricular infarction (RVI) complicated by hypotension. BACKGROUND: IABP improves hypotension in patients with acute myocardial infarction and left ventricular shock, but the effects have not been well studied in acute RVI with predominant right ventricular shock. METHODS: We retrospectively analyzed hemodynamics and clinical outcomes in 32 patients with acute inferior ST elevation myocardial infarction complicated by RVI, in whom hypotension requiring IABP placement developed despite intact left ventricular ejection fraction. RESULTS: Pre-IABP hypotension was present in all (100%) patients, and in every case IABP augmentation increased mean arterial pressure (55.9±7.4 to 76.8±14.7 mmHg, P<0.0001). Adverse clinical events included respiratory distress requiring intubation in 46.9%, cardiopulmonary resuscitation in 25%, episodes of ventricular tachycardia/fibrillation in 56.3%, and transvenous pacemaker placement in 56.3% of patients. There were six inhospital deaths (18.8%). Pre-IABP hemodynamics were similar in those patients who survived to discharge compared with those who died. However, in those patients who died, there was significantly lower augmentation of peak systolic blood pressure during IABP support compared with survivors (2.7±17 vs. 27±22 mmHg, P<0.015). CONCLUSION: IABP support results in immediate hemodynamic improvement in patients with acute RVI complicated by shock. The majority of these shock patients survived and the magnitude of mean arterial pressure and peak systolic blood pressure augmentation may impart prognostic value.