Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
Catheter Cardiovasc Interv. 2022 Feb;99(2):293-304. doi: 10.1002/ccd.29800. Epub 2021 May 28.
Randomized studies of intra-aortic balloon pump (IABP) in cardiogenic shock (CS) have only included on patients with acute coronary syndromes (ACS) without stratification according to shock severity. We examined the association between IABP and mortality in CS patients across the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages.
We included cardiac intensive care unit patients admitted from 2007 to 2015 with CS from any etiology. In-hospital mortality associated with IABP was examined in each SCAI shock stage. Multivariable logistic regression was performed using inverse probability of treatment weighting (IPTW) to determine the association between IABP and in-hospital mortality.
We included 934 patients, with a mean age of 68 ± 14 years; 60% had ACS. The distribution of SCAI shock stages was: B, 41%; C, 13%; D, 38%; E, 8%. In-hospital mortality was lower in the 39% of patients who received IABP (27% vs. 43%, adjusted OR with IABP after IPTW 0.53, 95% CI 0.40-0.72, p < .0001). IABP use was associated with lower crude in-hospital mortality in each SCAI shock stage (all p < .05, except p = .08 in SCAI shock stage E). We did not observe any significant heterogeneity in the association between IABP use and in-hospital mortality as a function of SCAI shock stage.
Patients with CS who were selected to receive an IABP had lower in-hospital mortality, without differences in this effect across the SCAI shock stages. Future studies should account for the severity and etiology of shock when evaluating the efficacy of IABP for CS.
随机的主动脉内球囊泵（IABP）在心源性休克（CS）中的研究仅包括急性冠状动脉综合征（ACS）患者，而没有根据休克严重程度进行分层。我们研究了 IABP 在心源性休克患者中的死亡率与心血管造影和介入学会（SCAI）休克分期之间的关系。
我们纳入了 2007 年至 2015 年期间因任何病因导致 CS 而从心脏重症监护病房住院的患者。在每个 SCAI 休克分期中，我们检查了 IABP 与住院死亡率之间的关系。采用逆概率治疗加权（IPTW）进行多变量逻辑回归，以确定 IABP 与住院死亡率之间的关系。
我们纳入了 934 例患者，平均年龄为 68±14 岁；60%的患者有 ACS。SCAI 休克分期分布为：B 期 41%；C 期 13%；D 期 38%；E 期 8%。接受 IABP 治疗的患者住院死亡率较低（27% vs. 43%，经 IPTW 校正后 IABP 的调整比值比为 0.53，95%可信区间为 0.40-0.72，p<0.0001）。在每个 SCAI 休克分期，IABP 的使用均与较高的住院死亡率相关（所有 p<0.05，除了 SCAI 休克分期 E 中 p=0.08）。我们没有观察到 IABP 使用与住院死亡率之间的关系随着 SCAI 休克分期的变化而出现显著的异质性。
选择接受 IABP 治疗的 CS 患者住院死亡率较低，而且在不同的 SCAI 休克分期中，这种效果没有差异。未来的研究应该在评估 IABP 治疗 CS 的疗效时考虑到休克的严重程度和病因。
