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IABP implantation trends after the trials - when it gets critical, do we follow guidelines?
Session:
Sessão de Posters 04 - Choque cardiogénico
Speaker:
Catarina Sena Silva
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Cartazes
FP Number:
---
Authors:
Catarina Sena Silva; João R. Agostinho; Ana Margarida Martins; Catarina Simões de Oliveira; Ana Beatriz Garcia; Catarina Gregório; Tatiana Guimarães; Rafael Santos; Hugo Côrte-Real; Cláudia Jorge; Pedro Cardoso; Fausto J. Pinto
Abstract
<p><strong>Introduction</strong><br /> Despite the improvements in cardiogenic shock (CS) management, mortality rate is still high. In this setting, intra-aortic balloon pump (IABP) had been widely used especially in acute coronary syndromes (ACS).<br /> However, following the 2012 published IABP-SHOCK II trial and the resulting class III, level B recommendation in the following ESC guidelines, its use was expected to decrease dramatically. So, evaluating the trends in IABP utilization is of utmost importance. This study aimed to characterize a real world non-controlled population in which IABP was employed as part of clinical care in a tertiary center between 2012 and 2022.</p> <p> </p> <p><strong>Methods</strong><br /> Single center retrospective observational study conducted in a tertiary hospital. Clinical data bases were searched for use of IABP in the last 10 years. We then collected clinical, laboratorial, echocardiography and cath data at time of implantation and during follow-up.</p> <p> </p> <p><strong>Results</strong><br /> We gathered a total of 119 pts (68% male, mean age 67.1 ± 12.4years) who presented with CS during the studied 10 years. The main indication was ACS, in 90.8%, and advanced heart failure in the remainder of pts. 85 pts (71.4%) presented with STEMI, whereas 24 (20.2%) presented with NSTEMI. Anterior descending artery was the culprit vessel in most cases. In 13 pts (8.4%) there was a mechanical complication motivating the implantation of IABP - intraventricular rupture was the most frequent followed by papillary muscle rupture. In 15 pts IABP was used as a complement to ECMO therapy. Mean ejection fraction was 33.1± 13.8% and mean lactate level was 5.85 ± 4.6 mmol/L. <br /> There was a high mortality rate during follow-up with a 30-day mortality rate of 63% (in line with previous trials) and a 1-year mortality rate of 71%, accordingly with the severity of the clinical presentation. 30% of pts had electrical disturbances during IABP support - ventricular tachycardia and electrical storm were responsible for about half the cases.<br /> We analyzed yearly trends of IABP implantation and noticed a steep decrease from 2012, up to 2016. Interestingly, we noticed a rise in implantation rate after 2017, with 2022 numbers matching those of 2012 – Figure 1.</p> <p> </p> <p><strong>Conclusion</strong><br /> In our population, IABP’s were used mainly in the setting of acute coronary syndrome with CS.Even though its implantation suffered a decrease after 2012, in more recent years there was renewed interest in this mechanical support technique. Such trend can be explained by increasing number of primary angioplasty in older patients with severe comorbidities, a significant rise in mechanical complications during COVID-19 pandemic and, foremost, introduction of ECMO therapy in our center (coupled with left ventricle venting using IABP).<br /> As expected in the setting of critical clinical presentation, our study shows a high 30-day mortality rate, followed by a stabilization after discharge, suggesting most who survive critical phase evolve favorably.</p>
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