SPC365

IABP in cardiogenic shock – aftermath 10 years apart from IABP-SHOCK trial

Session: Posters (Sessão 1 - Écran 6) - Cuidados Intensivos em Síndromes Coronárias Agudas
Speaker: Ana Margarida Martins

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.4 Acute Coronary Syndromes – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Ana Margarida Martins; João R. Agostinho; Pedro Alves da Silva; Beatriz Valente Silva; Joana Brito; Catarina Oliveira; Beatriz Garcia; Catarina Gregório; Miguel Raposo; Ana Abrantes; João Fonseca; Rafael Santos; Tatiana Guimarães; Cláudia Jorge; Miguel Nobre de Menezes; Hugo Corte-Real; Fausto J.Pinto
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt">Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) has a dismal prognosis. Theoretically, intra-aortic balloon counterpulsation (IABP) could provide a hemodynamic benefit by afterload reduction and improvement in coronary perfusion, but, <span style="color:#212121"><span style="background-color:white">in 2012, </span></span>the IABP- SHOCK-II trial found no survival benefit. However, these results don&rsquo;t always reflect real-world data and different centers practices. This study aimed to compare outcomes of AMI-CS pts who implanted IABP with a matched population without IABP.</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt">Methods</span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white">Single center retrospective study was conducted. We searched for IABP use between 2012 and 2022 and selected pts with AMI-CS. Clinical, lab, echo and cath data were obtained at time of IABP and during FUP. IABP group (IABPG) was then compared with a case-controlled population matched by the type of AMI, age, ejection fraction and culprit vessel. Primary endpoint was defined as 30-day mortality. Secondary endpoint was defined as significant bleeding during hospital stay, peripheral ischemic complications, sepsis, stroke, anoxic encephalopathy and acute kidney injury (AKI). </span></span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white">Results</span></span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white">We enrolled 216 pts who had ACS-CS, 108 in each group. In the IABPG 67.6% were male, mean age of 67 </span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#212121"><span style="background-color:white">&plusmn;</span></span></span></span><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white"> 12.9 years, whereas in the control group (CG) 73.1% were male, 67 </span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#212121"><span style="background-color:white">&plusmn;</span></span></span></span><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white"> 11.6 years. In both groups, proportion of STEMI and NSTEMI was the same. In IABPG, 13 pts had mechanical complications (vs 5 in CG). IABP was used to perform LV unloading in 13 pts with ECMO therapy. Remainder characteristics are shown on table 1.&nbsp; </span></span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white">30-day mortality rate was significantly higher in the IABPG (61.5% vs 48.1%; p=0.015) (fig. 1). </span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white">Despite selecting case control-matched pts, lactate levels were significantly different between them (IABPG 5.9 vs CG 3.4mmol/L; p=0.001), suggesting that clinical severity at time of IABP implantation was higher. To best correlate both groups, we selected the bottom half pts based on median lactate levels in the IABPG </span></span></span><span style="font-size:11pt"><span style="color:black"><span style="background-color:white">(4,5 mmol/L</span></span></span><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white">). The 2 groups matched according to lactate had no differences regarding 30-day mortality (50%vs 48.1%; p=0.87) (fig 2).</span></span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white">We also compared IABP pts with ECMO with case-matched controls and noticed that survival rates were higher in the CG, without statistical </span></span></span><span style="font-size:11pt"><span style="color:black"><span style="background-color:white">significance (69%vs 46%, </span></span></span><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white">p=0.175) (fig 3).</span></span></span></span></span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white">Regarding secondary endpoints, sepsis and vascular complications (p&lt;0.001 and p=0.006) were higher in IABPG; conversely incidence of anoxic encephalopathy was lower in the IABPG (4.6% vs 13.2%, p=0.011). No differences were noted in respect to other endpoints.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white">Conclusion</span></span></span></strong></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="font-size:11pt"><span style="color:#212121"><span style="background-color:white">In our population, IABP use failed to show benefit in 30-day mortality and was even associated with a higher death rate, which might be explained by the use of IABP in more severe cases. In fact, when comparing populations with similar lactate, there were no differences. The same was seen in pts who also had ECMO therapy. IABP is not free of complications and its use should be restricted to selected pts.</span></span></span></span></span></span></p>