Prognostic relevance of intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: Nationwide population study in Taiwan

Intra‐aortic balloon pump (IABP) is the most widely used form of mechanical circulatory support in patients with cardiogenic shock. However, usefulness of IABP in this high risk patient population is conflicting. We examined whether the patient prognosis in Taiwan treated with IABP has improved when IABP was actively used for mechanical circulatory support. We used Taiwan’s National Health Insurance Research Database to retrospectively review 3145 (2358 men [75%]) cardiogenic shock patients who treated primary PCI due to acute myocardial infarction (AMI) between 2000 and 2012. Primary outcome was all cause mortality and secondary outcome was heart failure. A total of 1417 patients who received IABP therapy and 1728 patients who not received non-IABP were selected in this study. The mean age of IABP group and non-IABP group was 68.1±13.1 years and 67±13.3 years, respectively (p=0.02). Median follow-up time for death was 1.51 years in non-IABP group and 1.07 years in IABP group (p<0.0001). Median follow-up time for heart failure was 0.28 years in non-IABP group and 0.09 years in IABP group (p<0.0001). During follow-up period, the adjusted hazard ratio for overall mortality was 1.22 (CI 95% 1.10-1.35, p<0.0001) and for overall heart failure was 1.24 (CI 95% 1.08-1.41, p<0.001). Risk factors for all-cause mortality were previous heart failure, diabetes, chronic kidney disease and hypertension. In this nationwide, population-based, retrospective cohort study, we found that mortality rate and heart failure rate not declined in cardiogenic shock patients who underwent primary PCI plus IABP therapy. Therefore, new type of mechanical circulatory support such as Impella should be considered for high risk, cardiogenic shock patients with AMI.