Clinical experience with intra-aortic balloon counterpulsation over 10 years: a retrospective cohort study of 459 patients.

Abstract

OBJECTIVE:

The objective of this study was to identify prognostic predictors for the patients experiencing cardiogenic shock who required the institution of intra-aortic balloon counterpulsation (IABP).

DESIGN, SETTING, AND PATIENTS:

Patients with cardiogenic shock were retrieved from the clinical information system in National Taiwan University Hospital and classified according to their etiology: acute coronary syndrome (ACS), ST segment elevation myocardial infarction (STEMI), congestive heart failure (CHF), hemodynamic instability after post-coronary bypass graft operation (post-CABG) or after percutaneous intervention (post-PCI), and out-of-hospital cardiac arrest (OHCA) victims.

MEASUREMENTS:

Kaplan-Meier curves and Cox regression model were applied to evaluate the factors associated with survival.

MAIN RESULTS:

A total of 459 patients were found to belong to one of six etiology categories between 1995 and 2004. The 30-day mortality was highest in the OHCA group, followed by the STEMI, CHF, ACS, post-PCI, and post-CABG groups in a decreasing frequency (log rank p<0.001). Peak troponin I level was negatively associated with survival, and its effect largely paralleled with underlying etiology. Age and renal impairment were significant prognostic predictors for 30-day mortality (hazard ratio=1.031, p<0.001 and hazard ratio=1.266, p<0.001). Comparing to those manifested as OHCA who had the worst outcome, patients in the other etiology groups had significantly better survival.

CONCLUSIONS:

This study has illustrated that age, renal function, and etiology-related cardiac injury are predictors for in-hospital course and mortality in those who experienced cardiogenic shock with IABP. The optimal strategy for revascularization in this high-risk group needs further validation.

• Authors: Sheng-Nan Chang, Juey-Jen Hwang, Yih-Sharng Chen, Jou-Wei Lin, Fu-Tien Chiang
• Journal: Resuscitation (Resuscitation) Vol. 77 Issue 3 Pg. 316-24 (Jun 2008) ISSN: 1873-1570 [Electronic] Ireland
• PMID: 18314247 (Publication Type: Journal Article)

Topics

• Aged
• Cohort Studies
• Female
• Humans
• Intra-Aortic Balloon Pumping
• Male
• Prognosis
• Retrospective Studies
• Shock, Cardiogenic (mortality, therapy)
• Survival Rate
• Time Factors