Outcomes With Femoral IABP in Heart Failure and Acute Myocardial Infarction-Related Cardiogenic Shock

Background: Intra-aortic balloon pump (IABP) insertion has not been shown to improve mortality rates in acute myocardial infarction-related cardiogenic shock (AMI-CS) but is increasingly used in heart failure-related cardiogenic shock (HF-CS). Objective: We sought to compare IABP-related outcomes in patients with HF-CS and AMI-CS. Methods: The Cardiogenic Shock Working Group registry was queried for patients with CS receiving femoral IABPs as the first temporary mechanical circulatory support (tMCS) device. Patients were divided into those with AMI-CS or HF-CS and were excluded if they received the IABP in conjunction with venoarterial extracorporeal membrane oxygenation (VA-ECMO) or another device concomitantly. Outcomes, including rates of native heart survival (NHS) (ie, weaned from IABP and discharged), heart replacement therapy (HRT) (ie, bridge to durable left ventricular assist device or heart transplant), need for another tMCS device, and death, were recorded and compared between the 2 cohorts. Results: In total, 886 patients were supported by IABPs as the first tMCS device; of these, 407 (45.6%) had HF-CS and 384 (43.3%) had AMI-CS. Those with HF-CS were younger but had higher burdens of cardiovascular comorbidities than those with AMI-CS. Among the HF-CS cohort, 33.2% had NHS, and 26.7% were bridged to HRT without another tMCS device. In the AMI-CS cohort, 43.4% had NHS and 2.1% were bridged to HRT without another tMCS device. Mortality rates were higher in AMI-CS group (36.4% vs 20.6%; P < 0.001). Complication rates were higher in those with AMI-CS and in those needing another tMCS device. Conclusion: Patients with HF-CS were more likely to have a favorable outcome with IABPs than those with AMI-CS.