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It's Official: IABP Does Not Improve Mortality in Acute MI Patients with Shock

October 4, 2013

It's Official: IABP Does Not Improve Mortality in Acute MI Patients with Shock

  1. Beat J. Meyer, MD

One-year findings from the IABP-SHOCK II trial confirm that use of the device should not be routine in patients who undergo early revascularization.

  1. Beat J. Meyer, MD

Short-term data from the IABP-SHOCK II trial (NEJM JW Cardiol Aug 27 2012) showed no survival benefit with intra-aortic balloon counterpulsation (IABP) in patients with acute myocardial infarction (MI) complicated by shock, leading to an adjustment of American and European guideline recommendations from Class I to Class IIa and IIb, respectively. However, in a previous trial, early revascularization in cardiogenic shock, a significant mortality benefit emerged only at extended follow-up (NEJM JW Cardiol Mar 16 2001). Therefore, the, the IABP-SHOCK II researchers now present 12-month follow-up data.

More than 99% of the cohort completed 12-month follow-up. Death rates were similar in the IABP and control groups (52% and 51%, respectively). Rates of reinfarction, repeat revascularization, and stroke did not differ significantly between the two groups, nor did quality-of-life scores including mobility, self-care, usual activities, pain or discomfort, and anxiety or depression. Of note, baseline serum lactate — an easily obtained measure of the severity of end-organ hypoxia — was one of the strongest predictors of long-term mortality.

Comment

These results validate the downgrading of intra-aortic balloon counterpulsation therapy in the current guidelines. In patients with acute myocardial infarction complicated by shock, IABP may be considered in select circumstances but should not be used in patients with high lactate levels. Given the high overall mortality in these patients, further research should focus on novel therapeutic options.

  • Disclosures for Beat J. Meyer, MD at time of publication Leadership positions in professional societies CentraMed Organization (President)

Citation(s):

Reader Comments (2)

jean-claude thiranos,MD Physician, Anesthesiology, cardiac surgical intensive care UF 1108

nice work
How is the experience of the different centers?
Is IABP easy to install?
Was it too late?
How many patients on cardiogenic shock on MI were vasoplegic?

Matthew Carr MD Physician, Cardiology, Hospital

Lets not lose sight of the 10% crossovers from standard care to iabp. Someone must have thought these patientss were gonna die. Why were they not counted as deaths in the standard caregroup? Recalcualte the results after doing this !. ANd remember that thay had significant delay of the benefites of iabp.
This is quite a serious issue in my estimation . millions of dollars have been spent for treatments that yield a 10%overal mortality advantage (PCIvs thrombolytics in acute mi) , so I do not consider a 10% failure rate of "standard" treatment as meaningless.
Conflict of interest: saved many lives with timely IABP
MLC

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