Indications, results of therapy and factors which influence survival in patients treated with intra-aortic balloon counterpulsation

Abstract

Background and aim: During nearly 40 years of intraaortic balloon counterpulsation (IABP) application in advanced medical therapy more and more indications for this treatment have been proposed. Despite increasing experience with IABP, the clinical effects of IABP use are still unclear. The aim of this study was to determine results of IABP use and factors which influence survival in cardiogenic shock (CS) caused by different clinical disorders when treated with IABP.

Methods: 73 patients (mean age 58.3+/-12.6 years, 54 males) undergoing IABP were included in the study. Data were collected retrospectively. After analysis of the whole population a subgroup of patients admitted due to acute myocardial infarction (AMI) was evaluated. The in-hospital and overall mortality rates were assessed.

Results: In-hospital death occurred in 31 (42.5%) patients. Over half of these patients (n=17; 54.8%) died during first 7 days from admission. The main reason for IABP introduction was CS due to acute coronary syndrome (ACS) at admission in 62 (84.9%) patients. The in-hospital mortality in patients with AMI complicated by CS was 40.7%. The features which significantly influenced survival in patients with AMI were age--patients who died were older (64+/-8.9 vs. 58.6+/-9,1; p=0.0285), and ST segment changes--there was lower mortality rate in a subgroup with ST elevation AMI (18 vs. 6 patients, p=0.003). We also observed slightly higher incidence of anterior wall AMI in survivors than in non-survivors (p=0.06).

Conclusion: Our study presents several disorders which may be treated with IABP. Acute MI still remains the most frequent indication for IABP insertion. In the present study, AMI survivors and non-survivors, differed mainly in age, ST segment changes and infarction site. Non ST segment elevation AMI was associated with worse prognosis.