Cardiac Intensive Care Unit, Division of Cardiology, San Paolo Hospital, 17100 Savona, Italy.
Department of Molecular Medicine, Unit of Cardiology, University of Pavia, 27100 Pavia, Italy.
Medicina (Kaunas). 2023 Oct 11;59(10):1806. doi: 10.3390/medicina59101806.
. Recent guidelines have downgraded the routine use of the intra-aortic balloon pump (IABP) in patients with cardiogenic shock (CS) due to ST-elevation myocardial infarction (STEMI). Despite this, its use in clinical practice remains high. The aim of this study was to evaluate the prognostic impact of the IABP in patients with STEMI complicated by CS undergoing primary PCI (pPCI), focusing on patients with anterior MI in whom a major benefit has been previously hypothesized. We enrolled 2958 consecutive patients undergoing pPCI for STEMI in our department from 2005 to 2018. Propensity score matching and mortality analysis were performed. . CS occurred in 246 patients (8.3%); among these patients, 145 (60%) had anterior AMI. In the propensity-matched analysis, the use of the IABP was associated with a lower 30-day mortality (39.3% vs. 60.9%, = 0.032) in the subgroup of patients with anterior STEMI. Conversely, in the whole group of CS patients and in the subgroup of patients with non-anterior STEMI, IABP use did not have a significant impact on mortality. . The use of the IABP in cases of STEMI complicated by CS was found to improve survival in patients with anterior infarction. Prospective studies are needed before abandoning or markedly limiting the use of the IABP in this clinical setting.
. 近期指南因 ST 段抬高型心肌梗死（STEMI）已降级了常规使用主动脉内球囊反搏（IABP）治疗心原性休克（CS）患者。尽管如此，其在临床实践中的应用仍然很高。本研究旨在评估在接受直接经皮冠状动脉介入治疗（pPCI）的 STEMI 合并 CS 患者中 IABP 的预后影响，重点关注先前假设存在较大获益的前壁心肌梗死患者。 我们从 2005 年至 2018 年连续纳入 2958 例在我科接受 pPCI 的 STEMI 患者。进行了倾向性评分匹配和死亡率分析。. 246 例（8.3%）患者发生 CS；其中 145 例（60%）为前壁 AMI。在倾向性评分匹配分析中，IABP 的使用与前壁 STEMI 亚组 30 天死亡率降低相关（39.3% vs. 60.9%，=0.032）。相反，在 CS 患者的全组和非前壁 STEMI 患者亚组中，IABP 的使用对死亡率没有显著影响。. 在 STEMI 合并 CS 的情况下使用 IABP 可改善前壁梗死患者的生存率。在这种临床情况下，需要进行前瞻性研究以放弃或明显限制 IABP 的使用。
