Shenzhen University Health Science Center, Shenzhen, 518060, China.
Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China.
BMC Cardiovasc Disord. 2023 Aug 29;23(1):425. doi: 10.1186/s12872-023-03465-8.
The role of intra-aortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction (AMI) is still a subject of intense debate. In this study, we aim to investigate the effect of IABP on the clinical outcomes of patients with AMI complicated by cardiogenic shock undergoing percutaneous coronary intervention (PCI).
From the Medical Information Mart for Intensive Care (MIMIC)-IV 2.2, 6017 AMI patients were subtracted, and 250 patients with AMI complicated by cardiogenic shock undergoing PCI were analyzed. In-hospital outcomes (death, 24-hour urine volumes, length of ICU stays, and length of hospital stays) and 1-year mortality were compared between IABP and control during the hospital course and 12-month follow-up.
An IABP was implanted in 30.8% (77/250) of patients with infarct-related cardiogenic shock undergoing PCI. IABP patients had higher levels of Troponin T (3.94 [0.73-11.85] ng/ml vs. 1.99 [0.55-5.75] ng/ml, p-value = 0.02). IABP patients have a longer length of ICU and hospital stays (124 [63-212] hours vs. 83 [43-163] hours, p-value = 0.005; 250 [128-435] hours vs. 170 [86-294] hours, p-value = 0.009). IABP use was not associated with lower in-hospital mortality (33.8% vs. 33.0%, p-value = 0.90) and increased 24-hour urine volumes (2100 [1455-3208] ml vs. 1915 [1110-2815] ml, p-value = 0.25). In addition, 1-year mortality was not different between the IABP and the control group (48.1% vs. 48.0%; hazard ratio 1.04, 95% CI 0.70-1.54, p-value = 0.851).
IABP may be associated with longer ICU and hospital stays but not better short-and long-term clinical prognosis.
主动脉内球囊反搏（IABP）在心梗合并心源性休克患者中的作用仍存在争议。本研究旨在探讨 IABP 对行经皮冠状动脉介入治疗（PCI）的急性心肌梗死合并心源性休克患者的临床结局的影响。
从 MIMIC-IV 2.2 数据库中剔除 6017 例急性心肌梗死患者，分析 250 例接受 PCI 的急性心肌梗死合并心源性休克患者。比较 IABP 组和对照组在住院期间和 12 个月随访期间的院内结局（死亡、24 小时尿量、住 ICU 时间和住院时间）和 1 年死亡率。
30.8%（77/250）的心梗合并心源性休克行 PCI 患者植入了 IABP。IABP 组患者肌钙蛋白 T 水平更高（3.94 [0.73-11.85] ng/ml 比 1.99 [0.55-5.75] ng/ml，p 值=0.02）。IABP 组患者住 ICU 和住院时间更长（124 [63-212] 小时比 83 [43-163] 小时，p 值=0.005；250 [128-435] 小时比 170 [86-294] 小时，p 值=0.009）。IABP 的使用与较低的院内死亡率（33.8%比 33.0%，p 值=0.90）和增加的 24 小时尿量（2100 [1455-3208] ml 比 1915 [1110-2815] ml，p 值=0.25）无关。此外，IABP 组和对照组 1 年死亡率无差异（48.1%比 48.0%；风险比 1.04，95%CI 0.70-1.54，p 值=0.851）。
IABP 可能与 ICU 住院时间和住院时间延长有关，但与短期和长期临床预后改善无关。
