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Intra-aortic balloon implantation decreases mortality risk in cardiogenic shock
Patients who received an intra-aortic balloon near the beginning of the onset of cardiogenic shock had decreased risk for mortality at 30 days regardless of the etiology, according to a study published in The American Journal of Cardiology.
“Our study has the largest reported clinical cohort of [cardiogenic shock] patients from non-ACS cause and demonstrates the utility of early use of [intra-aortic balloon] regardless of the etiology of [cardiogenic shock],” wrote Burcu Gul, MD, and Lavanya Bellumkonda, MD, both from the section of cardiovascular medicine at Yale School of Medicine.
Researchers analyzed data from 193 patients (mean age, 69 years; 30% women) with cardiogenic shock who received support from an intra-aortic balloon between February 2013 and April 2017. Of these patients, 38% had cardiac arrest, and the mean left ventricular ejection fraction was 33.7%. Cardiogenic shock from ACS was seen in 69.4% of patients.
Thirty-day mortality occurred in 36% of patients. Patients who had an intra-aortic balloon placed less than 1 hour after the onset of cardiogenic shock had a lower rate of 30-day mortality compared with those who had the balloon implanted more than 1 hour after onset (24% vs. 49%; P = .001).
The percentage of patients who died rose as the number of inotropes after placement of an intra-aortic balloon increased, with a rate of 18% for patients who did not requite inotropes, 21% for those who needed one inotrope, 36% for patients who required two inotrope and 74% for those who needed three or more inotropes (P < .001).
Predictors of 30-day mortality after the implantation of an intra-aortic balloon included cardiac arrest on presentation, advancing age, number of required inotropes and time to intra-aortic balloon implantation.
Mortality rates were similar in patients with cardiogenic shock from ACS (34.3%) vs. those without ACS (40.7%; P = .39)
“Identification of predictors of response to [intra-aortic balloon] support would allow us to tailor therapy and reserve use of more powerful [temporary mechanical circulatory support] devices for patients that have more advanced stages of [cardiogenic shock],” Gul and Bellumkonda wrote. – by Darlene Dobkowski
Disclosures: The authors report no relevant financial disclosures.