Poster 1041: Intra-Aortic Balloon Pump Use in Acute-on-Chronic Heart Failure Cardiogenic Shock: Results from a Multicenter Retrospective Observational Study

Background: Intra-aortic balloon pump (IABP) implantation has been significantly reduced since IABP-SHOCK II trial did not show any clinical benefit in acute myocardial infarction (AMI)-related cardiogenic shock (CS).1 For a long time, AMI has been recognized as the first cause of CS; however, in the last years, acute-on-chronic heart failure (HF)-CS has become predominant. We hypothesized that in HF-CS population the use of IABP on top of optimal medical therapy (OMT) may decrease mortality.

Aim: To investigate if IABP on top of OMT could improve 28-days mortality in a HF-CS population.

Methods: Multicenter retrospective observational study including adult HF-CS patents admitted in three 3rd level centers Intensive Care Units (Niguarda Hospital - Milan, San Matteo Hospital - Pavia and Royal Brompton - London). Hemodynamic variables, SCAI class, pharmacological support and outcome data were collected. Independent samples t-test was applied to assess any difference between IABP vs. no-IABP groups; Kaplan-Meier and Cox’s regression (forward stepwise method) were performed as survival analysis on 28-days mortality.

Results: 160 patents (35.6% female, 61 [47-74] years-old) were included from three centers. Eighty patents received IABP on top of medical treatment (IABP group) while 80 did not (OMT group). Patents’ baseline characteristics are shown in Table 1. Patents who received IABP were younger, had lower systolic blood pressure (SBP), pulse pressure (PP) and lactate levels at baseline. In reference to catecholaminergic drugs, patents supported with IABP had lower norepinephrine doses and vasoactive inotropic score (VIS) at baseline. Survival analysis graphs are shown in Figure 1; IABP group had the lower 28-days mortality HR 0.510 [0.293-0.887], p 0.017. At Cox’s regression (Table 2), a significant effect on 28-days mortality was found for IABP (HR 0.510 [0.293-0.887], p 0.017), SCAI classification-stage D (HR 2.582 [1.315-5.072], p 0.006), VIS above 15 (HR 2.348 [1.407-
3.921], p 0.001) and SBP above 95 mmHg (HR 1.361 [1.016-1.823], p 0.039); no significant association was found for age above 61 years (p 0.091), mechanical ventilation (p 0.367), PP (0 0.081) and lactate (p 0.227).

Conclusions: Considering the specific pathophysiology of HF-CS, IABP may have a role in reducing mortality. These retrospective data need to be validated and compared with those deriving from ongoing randomized controlled trials.2-3

References
1. Thiele H. N Engl J Med. 2012;367(14):1287–96.
2. Morici N. J Card Fail. 2021;28(7):1202–16.
3. Morici N. Am Hear J. 2021;233:39–47.