Effects of intra-aortic balloon pump on in-hospital outcomes and 1-year mortality in patients with acute myocardial infarction complicated by cardiogenic shock

Fang et al. BMC Cardiovascular Disorders (2023) 23:425 https://doi.org/10.1186/s12872-023-03465-8 BMC Cardiovascular Disorders Open Access RESEARCH Effects of intra-aortic balloon pump on inhospital outcomes and 1-year mortality in patients with acute myocardial infarction complicated by cardiogenic shock Dingfeng Fang1,2† , Dongdong Yu2†, Jiabin Xu2, Wei Ma2, Yuxiang Zhong2 and Haibo Chen2* Abstract Background The role of intra-aortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction (AMI) is still a subject of intense debate. In this study, we aim to investigate the effect of IABP on the clinical outcomes of patients with AMI complicated by cardiogenic shock undergoing percutaneous coronary intervention (PCI). Methods From the Medical Information Mart for Intensive Care (MIMIC)-IV 2.2, 6017 AMI patients were subtracted, and 250 patients with AMI complicated by cardiogenic shock undergoing PCI were analyzed. In-hospital outcomes (death, 24-hour urine volumes, length of ICU stays, and length of hospital stays) and 1-year mortality were compared between IABP and control during the hospital course and 12-month follow-up. Results An IABP was implanted in 30.8% (77/250) of patients with infarct-related cardiogenic shock undergoing PCI. IABP patients had higher levels of Troponin T (3.94 [0.73–11.85] ng/ml vs. 1.99 [0.55–5.75] ng/ml, p-value = 0.02). IABP patients have a longer length of ICU and hospital stays (124 [63–212] hours vs. 83 [43–163] hours, p-value = 0.005; 250 [128–435] hours vs. 170 [86–294] hours, p-value = 0.009). IABP use was not associated with lower in-hospital mortality (33.8% vs. 33.0%, p-value = 0.90) and increased 24-hour urine volumes (2100 [1455–3208] ml vs. 1915 [1110–2815] ml, p-value = 0.25). In addition, 1-year mortality was not different between the IABP and the control group (48.1% vs. 48.0%; hazard ratio 1.04, 95% CI 0.70–1.54, p-value = 0.851). Conclusion IABP may be associated with longer ICU and hospital stays but not better short-and long-term clinical prognosis. Keywords Intra-aortic balloon pump, Acute myocardial infarction, Cardiogenic shock, Mortality, Percutaneous coronary intervention † Fang and Yu contributed equally as co-first authors. *Correspondence: Haibo Chen 1 Shenzhen University Health Science Center, Shenzhen 518060, China 2 Department of Cardiology, Shenzhen Second People’s Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen 518035, China © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Fang et al. BMC Cardiovascular Disorders (2023) 23:425 Introduction Cardiogenic shock is a life-threatening complication of acute myocardial infarction (AMI) in nearly 5-10% of patients [1]. The mortality of AMI complicated by cardiogenic shock remain unacceptably high at rates between 40 and 60% even when the patients undergo early revascularization [2–4]. Intra-aortic balloon pump (IABP) has been the most widely used percutaneous mechanical circulatory support (PMCS) device for several decades. The effects of IABP are believed to increase the myocardial oxygen supply/demand ratio and thus improve prognosis. Because registry studies indicated mortality benefits, former U.S. and European guidelines gave a class I.B. and class I.C. recommendation favoring IABP in patients with AMI complicated by cardiogenic shock [5–7]. However, the results of the largest randomized trial (the IABPSHOCK-II [Intra-aortic Balloon Pump in Cardiogenic Shock-II study]) showed that IABP counterpulsation did not reduce 30day, 1year and 6-year mortality in cardiogenic shock complicating AMI undergoing early revascularization [8–10]. For this reason, the routine use of IABP in patients with infarct-related cardiogenic shock is no longer recommended by international guidelines [11, 12]. Unfortunately, the effective alternative PMCS devices for infarct-related cardiogenic shock are very limited. Therefore, the use of IABP was continued despite the paucity of survival benefit evidence based on randomized clinical trials [8–10, 13]. This study was designed to test the hypothesis that IABP can reduce mortality among patients with AMI complicated by cardiogenic shock undergoing percutaneous coronary intervention (PCI). Materials and methods Data source This research was performed on a large critical-care database, namely, Medical Information Mart for Intensive Care (MIMIC)-IV, which comprised critical care data for patients admitted to intensive care units at the Beth Israel Deaconess Medical Center (BIDMC) [14, 15]. The latest version, MIMIC-IV 2.2, was updated in January 2023 and contained comprehensive clinical and laboratory data of patients. The date of death is determined by state and hospital records. If both exist, hospital records are used. MIMIC-IV collected state and hospital records for the date of death two years after the last patient discharge, which could lessen the impact of reporting delays in the date of death. The first author (DF) of this study passed the Protecting Human Research Participants exam (certification number: 50,924,352) to obtain the utility of the database. Data extraction from the database was done using the structured query language (SQL). Page 2 of 7 Population selection criteria Patients with acute myocardial infarction admitted for the first time were included. Patients without infarctrelated cardiogenic shock and those without percutaneous coronary intervention were excluded from the study. The flowchart of population selection is displayed in Fig. 1. Outcomes and covariates The extraction variables included age, gender, diagnosis of STEMI, diagnosis of chronic total occlusion (CTO), history (hypertension, diabetes, tobacco, prior myocardial infarction, prior chronic kidney disease), arterial blood gas on arrival (pH, partial pressure of oxygen [PaO2], partial pressure of carbon dioxide [PaCO2], lactate), baseline serum creatinine, hemoglobin, (...truncated)