Azazy Ahmed, Farid Walaa Abdaziz, Ibrahim Walid Abdu, El Shafey Wassam ELDin Hadad
Department of Cardiology, King Saud Medical City, Riyadh, Saudi Arabia.
Department of Cardiology, Menofiya University Hospital, Shebin El Kom, Egypt.
Egypt Heart J. 2024 Aug 6;76(1):99. doi: 10.1186/s43044-024-00527-w.
Cardiogenic shock (CS) remains a major cause of in-hospital mortality in the setting of acute myocardial infarction (AMI). However, little evidence is available regarding the optimal order of intra-aortic balloon counter-pulsation (IABP) insertion and primary percutaneous coronary intervention (PPCI). The aim of this study was to assess the hospital and short-term survival benefits of two different IABP insertion approaches, before versus after PPCI in patients with acute myocardial infarction and cardiogenic shock.
Total mortality was 80 patients representing 48.4% of the total 165 studied patients; 60 patients died during the hospital admission period, while the remaining 20 patients died post-discharge. In-hospital mortality was significantly higher in Post-PPCI-IABP group 40 (49.4%) versus Pre-PPCI-IABP group 20 (23.8%) (P = 0.001). Moreover, the mortality difference between the two groups was sustained over six-month follow-up period, where 15 patients (18.5%) died in the Post-PPCI-IABP group, while only 5 patients 6.0% died in the Pre-PPCI-IABP (P = 0.001).
Early IABP insertion before PPCI is associated with improved in-hospital and long-term survival when used for patients presenting with AMI complicated by hemodynamic instability.
心源性休克（CS）仍是急性心肌梗死（AMI）住院患者死亡的主要原因。然而，关于主动脉内球囊反搏（IABP）置入与直接经皮冠状动脉介入治疗（PPCI）的最佳顺序，目前证据有限。本研究旨在评估急性心肌梗死合并心源性休克患者在PPCI之前与之后两种不同IABP置入方法对住院及短期生存的益处。
总死亡人数为80例，占165例研究患者总数的48.4%；60例患者在住院期间死亡，其余20例患者在出院后死亡。PPCI后IABP组的住院死亡率显著高于PPCI前IABP组，分别为40例（49.4%）和20例（23.8%）（P = 0.001）。此外，两组之间的死亡率差异在六个月的随访期内持续存在，PPCI后IABP组有15例患者（18.5%）死亡，而PPCI前IABP组仅有5例患者（6.0%）死亡（P = 0.001）。
对于合并血流动力学不稳定的AMI患者，在PPCI之前早期置入IABP可改善住院及长期生存情况。
