Intra-aortic balloon pump in acute myocardial infarction and cardiogenic shock,efficiency, safety and mortality risk factors

Background and methodsCardiogenic shock remains one of the leading causes of death in patients with myocardial infarction. The Intra-aortic balloon pump (IABP) has been widely used as a treatment for acute myocardial infarction (AMI), despite recommendations against its routine use. In this paper, our aim is to analyze and share our own experience with IABP in the setting of AMI. We retrospectively reviewed the files of patients admitted with AMI and cardiogenic shock and for whom IABP was inserted between June 2016 and December 2022.Results300 patients with AMI and cardiogenic shock were admitted and benefited from IABP insertion and primary coronary revascularization. The overall mortality rate was 62.3%, the site related complication rate was 0.6%, and the overall complications rate (including site related and major bleeding) was 10.6%. There was a significantly higher mortality in the group of patients where the Left Anterior Descending artery (LAD) was the culprit lesion, in the group of patients who required dialysis, the group who had creatinine levels greater than 200 um/L compared to the group who had creatinine lower than 200 um/L, and in patients older than 70 years. Interestingly, no difference in mortality was observed between men and women, single versus multiple vessel disease, and between STEMI and non-STEMI patients.ConclusionMortality of AMI complicated by cardiogenic shock and treated by IABP remains high. However, IABP usage is associated with a low complication rate. Better selection criteria for IABP usage versus other more powerful mechanical circulatory support devices in such patients might improve the outcome for the patient.     

Use of Intraaortic Balloon Counterpulsation in Patients Presenting With Cardiogenic Shock: Observations From the GUSTO-I Study

Objectives. We sought to examine the use, complications and outcomes with early intraaortic balloon counterpulsation (IABP) in patients presenting with cardiogenic shock complicating acute myocardial infarction and treated with thrombolytic therapy.Background. The use of IABP in patients with cardiogenic shock is widely accepted; however, there is a paucity of information on the use of this technique in patients with cardiogenic shock who are treated with thrombolytic therapy.Methods. Patients who presented within 6 h of chest pain onset were randomized to one of four thrombolytic regimens. Cardiogenic shock was not an exclusion criterion, and data for these patients were prospectively collected. Patients presenting with shock were classified into early IABP (insertion within one calendar day of enrollment) or no IABP (insertion on or after day 2 or never).Results. There were 68 (22%) IABP placements in 310 patients presenting with shock. Early IABP use occurred in 62 patients (20%) and none in 248 (80%). Most IABP use occurred in the United States (59 of 68 IABP placements) involving 32% of U.S. patients presenting with shock. Despite more adverse events in the early IABP group and more episodes of moderate bleeding, this cohort showed a trend toward lower 30-day and 1-year mortality rates.Conclusions. IABP appears to be underutilized in patients presenting with cardiogenic shock, both within and outside the United States. Early IABP institution is associated with an increased risk of bleeding and adverse events but a trend toward lower 30-day and 1-year all-cause mortality.     

应用主动脉内球囊反搏结合血管重建术治疗急性心肌梗死并发泵衰竭患者的效果

目的:观察应用主动脉内球囊反搏（IABP）结合血管重建术治疗急性心肌梗死并发泵衰竭患者的效果。方法: 2004年12月~2010年12月我院确诊急性心肌梗死并发泵衰竭并应用IABP的住院患者75（男54,女21）例。按是否做血管重建术分为两组:血管重建组和非血管重建组。所有患者均在药物治疗的基础上行IABP,所用反搏仪为AUTO CAT2或Datascope 98 system,血管重建组并行冠状动脉造影及经皮冠状动脉介入术(PCI)或冠脉旁路移植术（CABG）。结果: 全部75例患者中,IABP反搏时间2～336（90±75） h;死亡22例,病死率29%;血管重建组中63例行PCI术,1例行择期CABG,术后死亡14例,病死率22%;非血管重建组中死亡8例,病死率73%。血管重建组的病死率显著低于非血管重建组（P<0.01）,并发症共5例,发生率7%。结论: 在IABP的支持下,积极进行血管重建治疗可以降低急性心肌梗死并发泵衰竭患者的住院期间病死率。     

Revascularization,stenting, and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock

Randomized clinical trials have demonstrated a reduction in mortality with early revascularization of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock, and recent single-center studies have particularly suggested further benefit for coronary stenting. The purpose of this study was to examine the use of revascularization and coronary stenting for patients with shock from a multicenter, international perspective. Patients with AMI complicated by cardiogenic shock (n = 583) who enrolled between April 1999 and June 2001 were prospectively identified from the large, multinational, observational Global Registry of Acute Coronary Events. We examined the use of coronary reperfusion strategies, adjunctive therapy, and hospital mortality in this group of patients. Cardiac catheterization (52%) and revascularization (43%) were performed in approximately half of the cardiogenic shock patients. Elderly patients (age >/=75 years) comprised 40% of the shock cohort. Regional differences were seen in the use of revascularization, adjunctive medical therapy, and type of revascularization used (coronary stenting). Total hospital mortality was 59%, but case fatality rates ranged from 35% for patients who underwent coronary stenting to 74% for patients who did not undergo any cardiac catheterization. Percutaneous coronary intervention with coronary stenting was the most powerful predictor of hospital survival (odds ratio 3.99, 95% confidence interval 2.41 to 6.62). Thus, cardiogenic shock continues to be a devastating complication of AMI, and relative underuse of a revascularization strategy may be related to the large proportion of elderly patients in this population. In this multinational registry study, coronary stenting was the most powerful independent predictor of hospital survival.     

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

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.     

急性心肌梗死患者主动脉内球囊反搏术后下呼吸道感染风险及与预后关系

目的:探讨主动脉内球囊反搏(IABP)救治的急性心肌梗死(AMI)心源性休克患者发生下呼吸道感染的危险因素及对预后的影响.方法:回顾55例接受IABP治疗的AMI心源性休克患者,Logistic回归分析住院期间下呼吸道感染的危险因素,评估感染对预后的影响.结果:43.6％ IABP治疗的AMI心源性休克患者发生下呼吸道感染,有创机械通气、输血(血液制品)、未预防性使用抗生素、深静脉置管者发生感染的机会比较大(P＜0.05).感染患者病死率明显高于非感染者(75.0％ vs 38.7％,P=0.007);心源性休克、感染性休克和多器官功能不全是下呼吸道感染患者主要的死因.结论:下呼吸道感染与有创通气、深静脉置管、输血或血液制品有关;预防性使用抗生素减少感染风险.     

Improved survival of patients with acute myocardial infarction with significant left ventricular dysfunction undergoing invasive coronary procedures

BACKGROUND: Acute myocardial infarction (AMI) associated with significant left ventricular dysfunction (LVD) indicates a poor prognosis. Previous studies suggested that revascularization improves survival of patients with AMI complicated by cardiogenic shock. However, other studies that suggested that revascularization improves survival of stable patients with significant LVD did not specifically address patients who had recently had an AMI. OBJECTIVES: Our purpose was to determine whether patients with thrombolysis-treated AMI associated with significant LVD are likely to incur a survival advantage from catheterization and coronary revascularization performed within 30 days after AMI. METHODS: The study population was drawn from the Argatroban in Acute Myocardial Infarction-2 (ARGAMI-2) trial, which included 1200 patients with AMI, all of whom received thrombolytic therapy. Our analysis included 737 patients for whom LV function was estimated by echocardiography. Two hundred two patients had significant LVD; of them, 117 (58%) underwent cardiac catheterization and 85 were treated noninvasively. Among 535 patients without significant LVD, 291 (54%) underwent cardiac catheterization and 244 were treated noninvasively. RESULTS: Compared with a noninvasive approach, an invasive approach resulted in reduced 30-day and 6-month mortality rates in patients with significant LVD: 4.3% versus 10.6%, adjusted odds ratio (OR) 0.26, 95% confidence interval (CI) 0.04 to 1.18, and 6.1% versus 15.5%, OR 0.27, 95% CI 0.06 to 0.98, respectively. A similar comparison in patients without significant LVD resulted in comparable 30-day and 6-month mortality rates for both patient groups: invasively versus noninvasively treated, 0.7% versus 0.8%, OR 1.04, 95% CI 0.04 to 12.7, and 1.4% versus 1.7%, adjusted OR 1.60, 95% CI 0.20 to 9.87. CONCLUSIONS: The current study suggests that AMI patients with significant LVD may benefit from cardiac catheterization and revascularization performed early after AMI, whereas in patients without significant LVD the outcome of those treated invasively or conservatively was similar.     

主动脉内球囊反搏术在急性心肌梗死治疗中的应用和对近期预后的影响

目的了解急性心肌梗死（AMI）治疗中主动脉内球囊反搏术（IABP）的应用、并发症发生率和对近期预后的影响。方法单中心注册研究。连续入选2004年10月至2008年7月间,就诊于北京安贞医院28病房置入IABP的所有AMI患者。结果806例AMI患者中,共有121例（15.0%）置入IABP。最常见指征为高危冠状动脉（冠脉）造影和（或）PCI术中和术后提供血流动力学支持（66.9%）和心源性休克（26.4%）。IABP置入成功率为98.3%,平均使用时间为34±16h。严重并发症发生率为0%。所有患者均进行了冠脉造影,93.4%在出院前施行了冠脉血管重建。总住院死亡率为13.2%（其中心源性休克患者34.4%）,住院死亡率因置入IABP指征不同和施行冠脉血管重建与否存在很大差异。结论IABP可成功应用于AMI的多种高危状况并提供必要的血流动力学支持,严重并发症罕见,联合冠脉血管重建治疗可降低死亡率。     

急诊PCI联合主动脉内球囊反搏对急性心肌梗死合并心源性休克的疗效

目的：探讨经皮冠状动脉介入治疗（PCI）联合主动脉球囊反搏术（IABP）治疗急性心肌梗死（AMI）心源性休克患者的临床疗效。方法：回顾性分析16例联合IABP行PCI治疗的AMI合并心源性休克患者的临床资料。结果：16例患者均成功置入IABP及行PCI术,IABP使用时间20～190（70.6±37.2）h,3例（18.75%）出现局部穿刺部位出血,经压迫后出血停止,除住院期间死亡1例（6.25%）,无重大并发症。结论：对于心源性休克患者,联合主动脉球囊反搏术行经皮冠状动脉介入治疗安全、有效。     

Intra-Aortic Balloon Pump May Grant No Benefit to Improve the Mortality of Patients With Acute Myocardial Infarction in Short and Long Term: An Updated Meta-Analysis

Intra-aortic balloon pump (IABP) has been extensively used in clinical practice as a circulatory-assist device. However, current literature demonstrated significantly varied indications for IABP application and prognosis.The objective of the study was to assess the potential benefits or risks of IABP treatment for acute myocardial infarction (AMI) complicated with or without cardiogenic shock.MEDLINE and EMBASE database were systematically searched until November 2014, using the terms as follows: IABP, IABC (intra-aortic balloon counterpulsation), AMI, heart infarction, coronary artery disease, ischemic heart disease, and acute coronary syndrome. Only randomized controlled trials (RCTs) that compared the use of IABP or non-IABP support in AMI with or without cardiogenic shock were included. Two researchers performed data extraction independently, and at the mean time, the risk of bias among those RCTs was also assessed.Of 3026 citations, 17 studies (n = 3226) met the inclusion criteria. There is no significant difference between IABP group and control group on the short-term mortality (relative risk [RR], 0.90; 95% confidence interval [CI], 0.77–1.06; P = 0.214) and long-term mortality (RR, 0.91; 95% CI, 0.79–1.04; P = 0.155) in AMI patients with or without cardiogenic shock. These results were consistent when the analysis was performed on studies that only included patients with cardiogenic shock, both on short-term mortality (RR, 0.91; 95% CI, 0.77–1.08; P = 0.293) and long-term mortality (RR, 0.95; 95% CI, 0.83–1.10; P = 0.492). Similar result was also observed in AMI patients without cardiogenic shock. Furthermore, the risks of hemorrhage (RR, 1.49; 95% CI, 1.09–2.04; P = 0.013) and recurrent ischemia (RR 0.54, 95% CI 0.37 to 0.79; P = 0.002) were significantly higher in IABP group compared with control group.We did not observe substantial benefit from IABP application in reducing the short- and long-term mortality, while it might promote the risks of hemorrhage and recurrent ischemia. Therefore, IABP may be not an optimal therapy in AMI with or without cardiogenic shock until more elaborate classification is used for selecting appropriate patients.     

Thrombolysis and Counterpulsation to Improve Survival in Myocardial Infarction Complicated by Hypotension and Suspected Cardiogenic Shock or Heart Failure: Results of the TACTICS Trial

Background: Sustained hypotension, cardiogenic shock, and heart failure all imply a poor prognosis in acute myocardial infarction (MI). We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation (IABP) to standard treatment for MI, in an international trial among hospitals without primary angioplasty capabilities.Methods: We randomized 57 patients with MI complicated by sustained hypotension, possible cardiogenic shock, or possible heart failure to receive either fibrinolytic therapy and IABP or fibrinolysis alone. The primary end point was all-cause mortality at 6 months.Results: In all, IABP was inserted in 27 of 30 assigned patients a median 30 minutes after fibrinolysis began and continued for a median 34 hours. Of the 27 patients assigned to fibrinolysis alone, 9 deteriorated such that IABP was required. The IABP group was at slightly higher risk at baseline, but the incidence of the primary end point did not differ significantly between groups (34% for combined treatment versus 43% for fibrinolysis alone; adjusted P = 0.23). Patients with Killip class III or IV showed a trend toward greater benefit from IABP (6-month mortality 39% for combined therapy versus 80% for fibrinolysis alone; P = 0.05).Conclusions: While early IABP use was not associated with a definitive survival benefit when added to fibrinolysis for patients with MI and hemodynamic compromise in this small trial, its use suggested a possible benefit for patients with the most severe heart failure or hypotension.Abbreviated Abstract. We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation to fibrinolytic therapy among 57 patients with acute myocardial infarction complicated by sustained hypotension, possible cardiogenic shock, or possible heart failure. The primary end point, mortality at 6 months, did not differ between groups (34% for combined treatment versus 43% for fibrinolysis alone [n = 27]; adjusted P = 0.23), although patients with Killip class III or IV did show a trend toward greater benefit from IABP (39% for combined therapy versus 80% for fibrinolysis; P = 0.05).     

Clinical usefulness of intraaortic balloon pumping in acute myocardial infarction complicated with cardiogenic shock, ventricular septal perforation and mitral regurgitation

The effects of intraaortic balloon pumping (IABP) were studied in 91 patients with acute myocardial infarction complicated with cardiogenic shock (75 pts), ventricular septal perforation (VSP) (12 pts), and/or mitral regurgitation (MR) (4 pts). Out of 44 pts with cardiogenic shock in whom IABP was performed, 14 pts could not recover from cardiogenic shock, 6 pts became dependent on IABP and 13 pts survived (29.5%). In contrast, out of the remaining 31 pts with cardiogenic shock who did not undergo IABP because of inability to insert IABP catheter or other reasons and were treated medically, only 3 pts survived (9.7%, p less than 0.05). After the initiation of IABP, BPd, CI, SVI, SWI, TMG increased significantly, and HR, CVP, PCWP, TPR decreased significantly. Comparison of hemodynamic parameters after the initiation of IABP showed that SVI and SWI at 24 hours were higher and CVP lower in survivors. Out of 7 pts with VSP who underwent IABP 2 pts were operated and survived. In conclusion: short-term mortality in pts with cardiogenic shock was significantly lower in IABP-treated group, hemodynamic parameters improved after IABP, survivors from cardiogenic shock had higher SVI, SWI, BPd, and lower CVP than non-survivors, patients with VSP and MR had worse prognosis in spite of IABP.     

Outcomes and early revascularization for patients > or = 65 years of age with cardiogenic shock

Hospital survival of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock has improved during recent years. It is unclear whether this mortality benefit also applies to elderly patients with cardiogenic shock. Elderly residents (age > or = 65 years) of the Worcester, Massachusetts metropolitan area (1990 census population = 437,000) hospitalized with confirmed AMI and cardiogenic shock in all metropolitan Worcester, Massachusetts hospitals between 1986 and 1997 constituted the sample of interest. We examined the use of coronary reperfusion strategies, adjunctive therapy, and hospital mortality in a cohort of 166 cardiogenic patients treated early in the reperfusion era (1986 to 1991) compared with 144 patients with AMI treated approximately 1 decade later (1993 to 1997). There was a significant increase in the use of an early revascularization strategy over time (2% vs 16%, p <0.001). Marked increases in use of antiplatelet therapy, beta blockers, and angiotensin-converting enzyme inhibitors were also observed over the decade-long experience. In-hospital case fatality declined significantly over time, from 80% (1986 to 1991) to 69% (1993 to 1997) in elderly patients who developed cardiogenic shock (p = 0.03). After adjusting for differences in potentially confounding prognostic characteristics between patients hospitalized in the 2 study periods, an even more pronounced reduction in hospital mortality (42%) was observed for the most recently hospitalized cohort. The most powerful predictor of in-hospital survival was use of an early revascularization approach to treatment. Thus, hospital mortality has declined for patients > or = 65 years of age with AMI complicated by cardiogenic shock, and this decline has occurred in the setting of broader use of early revascularization and adjunctive medical therapy for this high-risk population.     

急性心肌梗死患者的直接经皮腔内冠状动脉成形术与溶栓治疗疗效比较

为探讨急性心肌梗死直接经皮腔内冠状动脉成形术的安全性及临床疗效 ,选择 6 2例未经静脉和冠状动脉内溶栓治疗的急性心肌梗死患者 ,在紧急冠状动脉造影后即行直接经皮腔内冠状动脉成形术 ;另外选择 5 9例急性心肌梗死患者 ,采用溶栓治疗 ,溶栓治疗后不再接受介入治疗和外科冠状动脉搭桥 ,然后比较直接经皮腔内冠状动脉成形术和溶栓治疗的疗效、安全性及预后。结果发现 ,直接经皮腔内冠状动脉成形术组 6 0例再灌注成功 ,成功率为 96 .7% ,其中 4例合并心源性休克的患者均再灌注成功 ,血压回升 ,急性上消化道出血 1例 ,死亡率为 0 ;溶栓治疗组 38例再灌注成功 ,成功率为 6 4 .4 % ,住院期间死亡 5例 ,出院 6月内死亡 2例 ,急性上消化道出血 1例 ,血尿 1例 ,溶栓治疗后心源性休克 5例 ,死亡率为 1 1 .9%。直接经皮腔内冠状动脉成形术再灌注成功率明显高于溶栓治疗 ,死亡率和主要心脏事件的发生率明显低于溶栓治疗 (P <0 .0 1 )。结果提示 ,急性心肌梗死的直接经皮腔内冠状动脉成形术治疗安全有效 ,再灌注成功率明显高于溶栓治疗 ,疗效及预后优于溶栓治疗     

老年急性心肌梗塞合并多器官功能衰竭临床分析

目的:探讨老年急性心肌梗塞(AMI)合并老年多器官功能衰竭(MOFE)的临床特点、治疗及转归。方法:回顾分析解放军总医院2004年1月至2006年12月所有238例老年AMI患者中的20例老年AMI合并MOFE患者的资料,分析这些患者的临床特点、治疗及转归。结果:老年广泛前壁AMI患者死亡率为80%;合并心源性休克的MOFE患者死亡率为60%;在老年AMI合并MOFE患者中以肺感染为诱因的占85%;老年AMI患者如合并脑血管基础性疾病,则死亡率为83.3%;在衰竭器官中,以心、肺、肾最为多见,分别占100%、80%、60%;早期介入治疗较溶栓治疗对患者的存活意义更大。结论:老年人AMI合并MOFE时心肌梗塞部位、是否合并心源性休克、脑血管基础疾病对患者预后影响非常大,心脏衰竭可能是老年AMI合并MOFE的始动因素,积极预防肺感染的发生、对合适病人早期实施介入治疗可能会逆转某些老年AMI患者发生MOFE的过程,或者提高救治成功率。     

主动脉内球囊反搏辅助治疗急性心肌梗死合并心源性休克的临床分析

目的分析主动脉内球囊反搏(IABP)辅助治疗急性心肌梗死合并心源性休克的临床疗效。方法选择急性心肌梗死合并心源性休克的老年患者50例,观察置入IABP前后患者血流动力学变化、心功能、IABP并发症及预后情况。结果与IABP置入前比较,患者置入IABP后平均动脉压、心率、LVEF及心功能指标均得到不同程度的改善,无严重并发症出现,预后良好。结论 IABP辅助治疗急性心肌梗死合并心源性休克可能有效安全。     

主动脉内球囊反搏在急性心肌梗死合并心源性休克治疗中的应用

目的评价主动脉球囊反搏术(IABP)在急性心肌梗死(AMI)合并心源性休克治疗中的应用价值。方法选取AMI合并心源性休克患者65例,其中IABP组30例,在IABP支持下行急诊经皮冠状动脉介入治疗(PCI),对照组35例,单纯行急诊PCI治疗。结果IABP组患者在IABP支持下,30 min后血流动力学指标改善,2~8 h血流动力学稳定,均完成梗死相关血管再通,没有血管再闭塞事件发生,无术中死亡,院内死亡率40%;对照组患者院内死亡率74.3%,其中6例在术中死亡。结论IABP可明显改善AMI合并心源性休克患者的血流动力学指标,增加冠状动脉的灌注;IABP可提高急诊PCI的成功率,减少术后低心排综合征及血管再闭塞事件的发生,降低院内死亡率,明显改善了AMI合并心源性休克患者的预后。     

Thrombolysis in acute myocardial infarction complicated by cardiogenic shock

The adverse impact of the development of cardiogenic shock in the setting of acute myocardial infarction was first described by Killip and Kimball in 1967. While the inhospital mortality rate in patients with myocardial infarction and no evidence of heart failure was only 6%, the mortality rate in those patients who developed cardiogenic shock was 81%. Despite advances in cardiovascular care and therapy since that initial report, including universal institution of cardiac care units, advances in hemodynamic monitoring, new inotropic and vasodilating agents, and even increasing utilization of thrornbolytic therapy, the mortality from acute myocardial infarction, when complicated by cardiogenic shock, remains disturbingly high, and cardiogenic shock remains the leading cause of death of hospitalized patients following acute myocardial infarction.The grave prognosis associated with this condition has resulted in increased interest in potential therapeutic interventions, particularly in the area of reperfusion therapy. Several studies suggest that, in contrast to the beneficial effects of thrombolytic therapy in most patient populations suffering acute myocardial infarction, mortality rates are not decreased in those patients with cardiogenic shock at the time of lytic administration. Thrombolytic administration does, however, appear to lead to a modest reduction in the percent of patients with myocardial infarction who will subsequently develop cardiogenic shock during hospitalization.Reperfusion rates with lytic therapy in patients with cardiogenic shock are disappointingly low, in the range of 42–48%, significantly lower than those achieved in patients without cardiogenic shock. These low perfusion rates may, in part, be explained by decreased coronary blood flow and perfusion pressure in patients with left ventricular pump failure.Although promising as adjunctive therapy, it is unclear whether institution of balloon counterpulsation has any long-term benefit in patients with cardiogenic shock treated with thrombolytic therapy. Whether other or additional interventions, such as coronary angioplasty and coronary artery bypass graft (CABG), decrease mortality rates in patients with cardiogenic shock remains to be determined.     

Impact of the Change in ESC Guidelines on Clinical Characteristics and Outcomes of Cardiogenic Shock Patients Receiving IABP Therapy

BackgroundIntra-aortic balloon pump (IABP) counterpulsation provides mechanical support for patients with cardiogenic shock. The aim of the study is to evaluate the clinical characteristics and outcomes of patients with cardiogenic shock receiving IABP before and after the European Society of Cardiology (ESC) downgraded the use of IABP from a class I to a class IIb in 2012.MethodsData was obtained from the Acute Coronary Syndrome Israeli Survey (ACSIS) registry, a prospective observational national survey conducted once every two years. From a total of 15,200 patients with acute coronary syndrome (ACS), 524 patients were identified with acute myocardial infarction (AMI)-complicated with cardiogenic shock. The groups were further subdivided based on whether the IABP was implanted before or after the change in guideline recommendation.ResultsThe study indicates a 24% reduction in IABP use since 2002. Until 2012, a reduction in clinical outcomes including 7-days, 30-days and in-hospital mortality, was observed in patients with IABP compared to the patients with conventional therapy. Conversely, after the ESC changed the guidelines, the clinical outcomes were not improved by IABP treatment. Additionally, the conventional therapy group presented with higher baseline ejection fraction, received less effective treatment, reperfusion and/or pharmacological therapy than patients with IABP.ConclusionThe use of IABP as management for cardiogenic shock has diminished over time since the guidelines were modified. After the change in guidelines, the use of IABP is restricted to high-risk, severely compromised and hemodynamically deteriorated patients hence limiting beneficial outcomes.     

主动脉内球囊反搏在急性心肌梗死并右心衰竭中的应用

目的：探讨主动脉内球囊反搏（IABP）在急性心肌梗死并右心衰竭中应用的价值。方法：69例急性心肌梗死并心源性休克行IABP辅助循环治疗患者中急性右心衰竭12例（17.4%）,回顾性分析此12例患者临床资料,病人年龄（64.1±9.7）岁,IABP辅助循环治疗时间15～288h,（95±76）h,9例（75%）行经皮冠状动脉介入术（PCI）。结果：12例患者住院期间主要并发症包括：出血3例（25%）,肢体缺血1例（8.3%）,急性肾功能衰竭2例（16.7%）,多器官功能衰竭1例（8.3%）。1例死于多器官功能衰竭,其余11例（91.7%）成功撤除IABP辅助循环,病情好转出院。结论：急性心肌梗死并严重右心衰竭死亡率高,在常规治疗疗效不佳时,主动脉内球囊反搏辅助循环治疗可能有益。