Predictors of Survival Study in Cardiogenic Shock Patients Treated With an Intra-Aortic Balloon Pump

December 11, 2018—A study of the predictors of survival in patients with cardiogenic shock (CS) treated with an intra-aortic balloon pump (IABP) concluded that early use of IABP in CS was associated with significant improvement in 30-day mortality regardless of the etiology of CS. The findings were published online by Burcu Gul, MD, et al in The American Journal of Cardiology (AJC).

The investigators sought to evaluate patient characteristics and impact of timing of IABP in treatment of CS. The study included patients at the Yale New Haven Hospital in New Haven, Connecticut, who presented in CS and received IABP between February 2013 and April 2017.

As summarized in AJC, the investigators assessed baseline characteristics and clinical predictors of 30-day mortality in 193 patients. The mean age was 68.8 ± 14.5 years, 30% were women, 38% had cardiac arrest, and the left ventricular ejection fraction was 33.7% ± 14.9%.

The investigators reported that overall 30-day mortality was 36%. When an IABP was placed within less than < 1 hour of onset of CS, 30-day mortality was 24%; when implanted ≥ 1 hour after recognition of CS, 30-day mortality was 49% (P = .001).

Mortality was 18%, 21%, 36%, and 74%, respectively, for patients requiring zero, one, two, and three or more inotropes after IABP placement (P < .001). In multivariate analysis, advancing age, cardiac arrest on presentation, time to IABP implantation, and number of inotropes needed after IABP implantation predicted 30-day mortality. Among the 193 patients, 134 (69.4%) presented with CS from acute coronary syndrome (ACS) and 59 (30.6%) with CS from non-ACS–related causes. No difference in mortality was noted between the ACS and non-ACS groups (34.3% vs 40.7%; P = .39).

Continued need for significant inotropic support after IABP use is associated with worse prognosis and may be used as an indicator for the need to escalate to higher levels of support, advised the investigators in AJC.