d'Almeida Sascha, Stephan Tilman, Weinig Sebastian, Felbel Dominik, Mayer Benjamin, Andreß Stefanie, Rottbauer Wolfgang, Buckert Dominik, Markovic Sinisa
Department of Cardiology, Angiology, Pneumology and Intensive Care Medicine, University of Ulm, Ulm, Germany.
Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
Catheter Cardiovasc Interv. 2025 Aug;106(2):1002-1011. doi: 10.1002/ccd.31653. Epub 2025 Jun 2.
There is little data questioning the timing of intra-aortic balloon pump (IABP) implantation in non-cardiogenic shock patients undergoing high-risk percutaneous procedures.
We compared prophylactic IABP (P-IABP) implantation to an emergent, unplanned rescue use (R-IABP) in high-risk PCI.
Among 300 IAPB patients who were treated at Ulm University Heart Center, Germany, between 2012 and 2020, we retrospectively selected and analyzed data from 59 patients. The cohort was subdivided into 44 P-IABP and 15 R-IAPB patients who underwent protected PCI with an IABP. Patients with cardiogenic shock at baseline, Impella-pump or extra corporal membrane oxygenator (ECMO) were excluded. Both elective and emergency patients with acute coronary syndrome were included.
Both groups showed no significant difference in the baseline characteristics. The achieved SYNTAX score reduction after PCI (delta SYNTAX) was higher in the P-IABP group (22.15 ± 10.31 points in the P-IAPB and 15.73 ± 10.13 points in the R-IABP group, p = 0.04). In addition, we observed lower highly sensitive Troponin T (hsTnT) peak values in the P-IAPB group after the intervention (2223.33 ± 3129.77 ng/L vs. 5823.85 ± 3885.35 ng/L, p = 0.001). P-IABP was associated with peak hsTnT values (p = 0.01). The 30-day mortality rates were not significantly different (p = 0.88).
Patients in the prophylactic-IAPB group experienced a more complete revascularization measured with the delta SYNTAX score compared to those in the rescue-IAPB group. Moreover, peri-interventional infarct size measured by hsTnT release was significantly lower. Both findings indicate that P-IABP implantation in high-risk PCI should be preferred to rescue IAPB use.
对于接受高风险经皮手术的非心源性休克患者，关于主动脉内球囊反搏（IABP）植入时机的数据较少受到质疑。
我们比较了在高风险经皮冠状动脉介入治疗（PCI）中预防性植入IABP（P-IABP）与紧急、非计划性挽救性使用（R-IABP）的情况。
在2012年至2020年期间于德国乌尔姆大学心脏中心接受治疗的300例IABP患者中，我们回顾性选择并分析了59例患者的数据。该队列被分为44例接受IABP保护下PCI的P-IABP患者和15例R-IABP患者。排除基线时患有心源性休克、使用Impella泵或体外膜肺氧合（ECMO）的患者。纳入急性冠状动脉综合征的择期和急诊患者。
两组在基线特征方面无显著差异。PCI后实现的SYNTAX评分降低（SYNTAX差值）在P-IABP组更高（P-IABP组为22.15±10.31分，R-IABP组为15.73±10.13分，p = 0.04）。此外，我们观察到干预后P-IABP组的高敏肌钙蛋白T（hsTnT）峰值较低（2223.33±3129.77 ng/L对5823.85±3885.35 ng/L，p = 0.001）。P-IABP与hsTnT峰值相关（p = 0.01）。30天死亡率无显著差异（p = 0.88）。
与挽救性IABP组相比，预防性IABP组患者通过SYNTAX差值评分衡量的血管重建更完整。此外，通过hsTnT释放测量的围手术期梗死面积显著更低。这两个发现表明，在高风险PCI中应优先选择预防性植入P-IABP而非挽救性使用IABP。
