Author + information
- Received January 28, 2018
- Revision received June 28, 2018
- Accepted July 17, 2018
- Published online September 17, 2018.
- Michał Hawranek, MDa,∗ (, )
- Marek Gierlotka, MDa,b,
- Damian Pres, MDa,
- Marian Zembala, MDc and
- Mariusz Gąsior, MDa
- a3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Centre for Heart Disease in Zabrze, Zabrze, Poland
- bDepartment of Cardiology, University Hospital in Opole, Faculty of Natural Sciences and Technology, University of Opole, Opole, Poland
- cDepartment of Cardiac, Vascular and Endovascular Surgery and Transplantology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases in Zabrze, Zabrze, Poland
- ↵∗Address for correspondence:
Dr. Michal Hawranek, Medical University of Silesia, Katowice, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Disease in Zabrze, 3rd Department of Cardiology, ul. Sklodowskiej-Curie 9, 41-800 Zabrze, Poland.
Objectives The authors sought to compare outcomes of patients with myocardial infarction and cardiogenic shock (CS) treated with percutaneous coronary intervention (PCI) with or without intra-aortic balloon pump (IABP) support according to final epicardial flow in the infarct-related artery.
Background A routine use of IABP is contraindicated in patients with myocardial infarction and CS. There are no data regarding the subpopulation of patients who may benefit from such support besides patients with mechanical complications of myocardial infarction.
Methods Prospective nationwide registry data of patients with myocardial infarction and CS treated with PCI between 2003 and 2014 were analyzed. Patients were initially stratified into 2 groups according to final infarct-related artery Thrombolysis In Myocardial Infarction (TIMI) flow grade after PCI: those with successful primary PCI (TIMI flow grades 2 or 3) and those with unsuccessful primary PCI (TIMI flow grades 0 or 1). Outcomes of patients with or without IABP treatment in each group were analyzed and compared.
Results In the unsuccessful PCI group, patients in whom IABP was applied had lower in-hospital, 30-day, and 12-month mortality. IABP support in this group of patients was an independent predictor of lower 30-day mortality (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.59 to 0.89; p = 0.002). Conversely, in patients with successful PCI, IABP was an independent predictor of higher 30-day mortality (HR: 1.18; 95% CI: 1.08 to 1.30; p = 0.0004).
Conclusions IABP is associated with a lower risk of 30-day mortality in patients with myocardial infarction complicated by CS, in whom primary PCI was unsuccessful.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received January 28, 2018.
- Revision received June 28, 2018.
- Accepted July 17, 2018.
- 2018 American College of Cardiology Foundation
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