The Preference, Effect, and Prognosis of Intra-Aortic Balloon Counterpulsation in Acute Myocardial Infarction Complicated by Cardiogenic Shock Patients: A Retrospective Cohort Study

Abstract

Backgrounds: Intra-aortic balloon counterpulsation is increasingly used in acute myocardial infarction complicated by cardiogenic shock. The aim of this study was to explore the preference, effect, and prognosis of intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock patients.

Methods: Data of acute myocardial infarction complicated by cardiogenic shock patients at the Fourth Medical Center of PLA General Hospital were collected retrospectively. A propensity score was calculated with a logistic regression which contained clinically meaningful variables and variables selected by Lasso and then used to match the control group. The cumulative incidence curve and Gray's test were employed to analyse the effect and prognosis of intra-aortic balloon counterpulsation on mortality.

Results: A total of 1962 acute myocardial infarction cases admitted between May 2015 and November 2018 were identified, and 223 cases with acute myocardial infarction complicated by cardiogenic shock were included as the study cohort, which contained 34 cases that received IABP and 189 cases that did not receive IABP. Patients with higher alanine aminotransferase (OR = 1.93, 95% CI 1.29-2.98), higher triglyceride (OR = 3.71, 95% CI 1.87-7.95), and higher blood glucose (OR = 1.08, 95% CI 0.99-1.18) had a higher probability of receiving intra-aortic balloon counterpulsation. In the propensity score matching analysis, 34 cases received intra-aortic balloon counterpulsation and 102 matched controls were included in the comparison. By comparing the cumulative incidence of in-hospital mortality, there was no statistically significant difference between the intra-aortic balloon counterpulsation group and matched control group (P = 0.454).

Conclusion: The use of intra-aortic balloon counterpulsation may not improve the prognosis of the acute myocardial infarction complicated by cardiogenic shock patients.

Figure 1

Flowchart of patient inclusion and the matching procedure. From a total of 1962 acute myocardial infarction cases in the Fourth Medical Center of PLA General Hospital, 223 cases met the acute myocardial infarction complicated by cardiogenic shock inclusion and exclusion criteria. Thirty-four cases received IABP, and 102 cases of matched pairs did not receive IABP.

Figure 2

Univariate analysis of factors for receiving IABP in the AMI-cardiogenic shock patients. ^∗The P value is between 0.05 and 0.001. ^∗∗The P value is <0.001. ^#Standardized OR, OR per SD increase for continuous variables, and OR compared to the reference group for categorical variables. NA: (quasi-) complete separation variables, where OR is not applicable.

Figure 3

Cumulative incidence curves for in-hospital mortality stratified by IABP. The cumulative incidence was used to assess the primary end point of mortality for the IABP group (red line) and the matched control group (blue line).

Figure 4

Univariate analysis of factors for mortality in the AMI-cardiogenic shock patients receiving IABP. ^∗The P value is between 0.05 and 0.001. ^∗∗The P value is <0.001; ^#Standardized HR, HR per SD increase for continuous variables, and HR compared to the reference group for categorical variables. NA: (quasi-) complete separation variables, where HR is not applicable.