Clinical InvestigationPredictors of intra-aortic balloon pump hemodynamic failure in non-acute myocardial infarction cardiogenic shock
Section snippets
Patient population and outcomes
A retrospective analysis was performed of all consecutive adult patients (age ≥ 18 years) hospitalized at a single tertiary-care hospital between July 2010 and June 2015 that underwent placement of an intra-aortic balloon pump. The study was approved by the institutional review board of the Johns Hopkins Medical Institution.
The target study population comprised patients with known or newly diagnosed cardiomyopathy who required IABP for treatment of cardiogenic shock. Patients were excluded if
Cohort characteristics
Out of the 474 patients who underwent IABP placement at Johns Hopkins Hospital between 2010 and 2015, 400 patients were excluded, yielding 74 patients in the final cohort. (Figure 1). These patients all had known or newly diagnosed cardiomyopathy and underwent IABP placement for the treatment of cardiogenic shock complicating non-AMI heart failure. The vast majority of these patients had cardiogenic shock complicating a known cardiomyopathy (89%). Of the 74 patients, 15 patients (20%) survived
Discussion
IABP counter-pulsation remains poorly studied in the setting of cardiogenic shock in the non-AMI setting. The current study identifies a cohort of non-AMI patients requiring IABP for cardiogenic shock and finds that despite initial hemodynamic improvement, nearly 30% of patients failed IABP support and went on to die or require urgent escalation in MCS. Low LVCPI (< 0.28 W/m2) at time of IABP implantation and history of ischemic cardiomyopathy proved to be the most powerful predictors of IABP
Conclusions
Despite significant hemodynamic improvement from IABP support in the treatment of cardiogenic shock in the non-AMI setting, many patients still fare poorly. In our cohort of cardiogenic shock patients undergoing IABP, low LVCPI (<0.28 W/m2) at the time of IABP implantation and history of ICM helped to predict significantly poorer 28-day outcomes. This may represent a cohort that warrants up-front consideration of more advanced MCS support, or at least close monitoring and consideration of MCS
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Author disclosures: All authors have no relationships with industry.
Financial Support: This study was supported by the National Institutes of Health-National Heart, Lung, and Blood Institute (T32-HL007227-40, S.H.).