Timing of IABP initiation and its impact on outcomes in acute myocardial infarction with cardiogenic shock: insights from a bi-center retrospective study

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2026年6月8日

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Istvan Bojti,
Sarolta Bojtine Kovacs,
David Kovacs,
Antonia Ziegler,
Alexander Maier,
Dirk Westermann,
Miroslaw Ferenc,
Attila Csaba Nagy,
Kalman Racz,
Zsolt Koszegi,
Gabor Tamas Szabo

摘要

Background

The optimal timing of intra-aortic balloon pump (IABP) initiation in cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains uncertain. Contemporary ESC guidance and the recent EACTS/STS/AATS MCS guideline highlight gaps regarding timing, patient selection, and ischemic burden. In this study, the association between IABP timing, myocardial area at risk (AAR), and survival in AMI-CS was evaluated.

Methods

We retrospectively analyzed 399 AMI-CS patients treated with primary PCI at two tertiary centers. Patients were categorized as no IABP (n = 124), non-rescue IABP (started during PCI; n = 216), or rescue IABP (inserted after PCI; n = 59). Clinical and angiographic parameters, including AAR quantified by a coronary anatomy–based algorithm, were assessed. Multivariable logistic regression identified predictors of in-hospital and 1-year mortality.

Results

Non-rescue IABP was independently associated with lower in-hospital mortality vs. no IABP (OR 0.29, 95% CI 0.16–0.52). Rescue IABP showed a weaker association with lower in-hospital mortality (OR 0.41, 95% CI 0.19–0.89). At 1 year, mortality was higher in both no IABP (OR 3.27, 95% CI 1.86–5.76) and rescue IABP groups (OR 2.04, 95% CI 1.04–3.98) compared with non-rescue IABP. An augmented inverse-probability weighted (AIPW) analysis confirmed these findings, demonstrating a significant reduction in 1-year mortality with early IABP use compared with no IABP (ATE − 0.24, 95% CI − 0.375 to − 0.104), whereas no significant effect was observed for rescue IABP. A significant interaction between AAR and timing indicated that early IABP offered the greatest benefit in patients with moderate AAR (30–55%), whereas no benefit was observed with extensive AAR (> 80%).

Conclusions

In AMI-CS, early IABP initiation was associated with improved in-hospital and long-term survival, particularly in patients with a moderate AAR. These findings support the need for refining IABP use based on both ischemic burden and the timing of hemodynamic support.

Trial registration number and date of registration.

DRKS00038637, 03.12.2025.

Graphical Abstract