Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.
Curr Opin Crit Care. 2013 Oct;19(5):404-9. doi: 10.1097/MCC.0b013e328364d78d.
Despite developments in treatment of myocardial infarction, mortality rates in cardiogenic shock remain unacceptably high. Intra-aortic balloon pumping (IABP) is to date the most used device for hemodynamic support, but randomized evidence on survival benefit was lacking.
A recently published meta-analysis with hints for higher mortality after primary percutaneous intervention challenged the previous high-grade recommendations for IABP. Therefore the use in cardiogenic shock was downgraded in the last versions of European and American guidelines from a class I to a class IIa and IIb recommendation, respectively. Furthermore, a large scale randomized trial found no benefit on 30-day mortality in patients with myocardial infarction complicated by cardiogenic shock. This result was supported by a lack of difference in all subgroups and secondary endpoints.
In cardiogenic shock, no general recommendation for IABP can be given. In the next revision of current guidelines, recent randomized trial results should be incorporated. Further research is needed to develop optional treatments in cardiogenic shock or to gain validated algorithms for use of active assist devices.
尽管心肌梗死的治疗已有进展，但心源性休克的死亡率仍居高不下。到目前为止，主动脉内球囊泵（IABP）是最常用于血液动力学支持的设备，但缺乏关于生存获益的随机证据。
最近发表的一项荟萃分析提示，在直接经皮冠状动脉介入治疗后死亡率更高，这对之前 IABP 的高级别推荐提出了挑战。因此，在欧洲和美国的最新指南版本中，IABP 的使用从 I 类降级为 IIa 和 IIb 类推荐，分别用于心源性休克。此外，一项大型随机试验发现，在心肌梗死合并心源性休克的患者中，30 天死亡率没有获益。这一结果得到了所有亚组和次要终点均无差异的支持。
在心源性休克中，不能普遍推荐使用 IABP。在当前指南的下一次修订中，应纳入最近的随机试验结果。需要进一步研究以开发心源性休克的可选治疗方法或获得有效的主动辅助装置使用算法。
