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Randomized Controlled Trial
. 2011 Aug;162(2):268-75.
doi: 10.1016/j.ahj.2011.04.025.

Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction

Krishnan Ramanathan  1 , Michael E Farkouh, John E Cosmi, John K French, Shannon M Harkness, Vladimír Džavík, Lynn A Sleeper, Judith S Hochman
Affiliations
Randomized Controlled Trial

Rapid complete reversal of systemic hypoperfusion after intra-aortic balloon pump counterpulsation and survival in cardiogenic shock complicating an acute myocardial infarction

Krishnan Ramanathan et al. Am Heart J. 2011 Aug.

Abstract

Background: In patients with cardiogenic shock (CS) complicating an acute myocardial infarction, a strategy of early revascularization (ERV) versus initial medical stabilization (IMS) improves survival. Intra-aortic balloon counterpulsation (IABC) provides hemodynamic support and facilitates coronary angiography and revascularization in CS patients.

Methods and results: We evaluated 499 patients with record of systemic hypoperfusion status as an early response to IABC from the SHOCK trial (n = 185) and registry (n = 314) to determine the association between rapid complete reversal of systemic hypoperfusion (CRH) after 30 minutes of IABC and in-hospital, 30-day and 1-year mortality. Rapid complete reversal of systemic hypoperfusion was highly associated with lower in-hospital mortality (29% versus 65%, P < .001) in all patients. In the SHOCK trial, among patients assigned to ERV versus IMS, 30-day mortality was 26% versus 29%, respectively, with CRH and 61% versus 81%, respectively, without CRH after commencing IABC. The corresponding 1-year mortality rates were 35% versus 52% for ERV and 69% versus 87% for IMS (interaction P ≥ .25 at both time points). After adjusting for important correlates of outcome (left ventricular ejection fraction, age, and randomization to ERV), a significant association remained between CRH and registry and trial in-hospital mortality (odds ratio 0.23, 95% CI 0.14-0.39, P < .001) and trial 1-year mortality (odds ratio .28, 95% CI 0.12-0.67, P < .001).

Conclusions: In CS patients, CRH after commencing IABC was independently associated with improved in-hospital, 30-day and 1-year survival regardless of early revascularization. In CS patients, CRH with IABC is an important early prognostic feature.

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Figures

Figure 1
Figure 1
The method of patient selection for analysis. SHOCK = SHould we revascularize Occluded Coronaries in cardiogenic shocK?; LV = left ventricular; IABC = intra-aortic balloon counterpulsation; CRF = case report forms; CRH = complete rapid reversal of systemic hypoperfusion; NCRH = non-complete rapid reversal of systemic hypoperfusion.
Figure 2
Figure 2
Kapan-Meier estimates of 30-day survival by response to IABC in the SHOCK Trial.
Figure 3
Figure 3
Kaplan-Meier estimates of 1-year survival by response to IABC in the SHOCK Trial.
See this image and copyright information in PMC

References

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