Impact of intra-aortic balloon pump support initiated before versus after primary percutaneous coronary intervention in patients with cardiogenic shock from acute myocardial infarction

Jin Ming Cheng, Mark Leeuwen, Sanneke Boer, MCGTJ Wai, Corstiaan Uil, Lucia Jewbali, Robert Jan van Geuns, Isabella Kardys, Ron van Domburg, Eric Boersma, Felix Zijlstra, Martijn Akkerhuis

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Abstract

Background: Little evidence is available on the optimal sequence of intra-aortic balloon pump (IABP) support initiation and primary percutaneous coronary intervention (PCI) in patients who present with cardiogenic shock from ST-elevation myocardial infarction (STEMI). The aim of this study was to evaluate the order of IABP insertion and primary PCI and its association with infarct size and mortality. Methods: A series of 173 consecutive patients admitted with cardiogenic shock from STEMI and treated with primary PCI and IABP between 2000 and 2009 were included. The order of IABP insertion and primary PCI was left at the discretion of the interventional cardiologist. Results: All baseline characteristics were similar in patients who first received IABP (n - 87) and patients who received IABP directly after PCI (n = 86). In these two groups, cumulative 30-day mortality was 44% and 37% respectively (p = 0.39). Median peak serum creatine kinase (CK) concentrations were 5692 U/l and 4034 U/l respectively (p = 0.048). In multivariable analysis, IABP insertion before PCI was independently associated with higher CK levels (p = 0.046). In patients who survived 30 da Conclusions: Early IABP insertion before primary PCI might be associated with higher peak CK levels, indicating a larger infarct size. A possible explanation may be the increased reperfusion delay. Our study suggests that early reperfusion could have priority over routine early IABP insertion in STEMI patients with cardiogenic shock. Randomized studies are needed to determine the optimal timing of IABP insertion relative to primary PCI. (C) 2013 Elsevier Ireland Ltd. All rights reserved.
Original languageUndefined/Unknown
Pages (from-to)3758-3763
Number of pages6
JournalInternational Journal of Cardiology
Volume168
Issue number4
DOIs
Publication statusPublished - 2013

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