Early IABP use in absence of cardiogenic shock in high risk protected PCI reduces infarction size and leads to more complete revascularization in comparison to rescue IAPB use

Sascha d´Almeida (Ulm)1, T. Stephan (Ulm)1, S. Weinig (Ulm)1, D. Felbel (Ulm)1, B. Mayer (Ulm)2, W. Rottbauer (Ulm)1, D. Buckert (Ulm)1, S. Markovic (Ehingen (Donau))3

1Universitätsklinikum Ulm Klinik für Innere Medizin II Ulm, Deutschland; 2Universitätsklinikum Ulm Institut für Biometrie, Epidemoilogie und Statistik Ulm, Deutschland; 3Alb-Donau Klinikum Innere Medizin Ehingen (Donau), Deutschland


Background: There is little data questioning the timing of intra-aortic balloon pump (IABP) implantation in stable and elective non-cardiogenic shock patients undergoing high-risk percutaneous procedure. We therefore compare prophylactic IABP (P-IABP) implantation to an emergent, unplanned use (R-IABP) in high risk PCI.

Methods: We retrospectively analyzed data from 59 patients who were treated at the heart center, University of Ulm (Germany) between 2012 and 2020. The cohort was subdivided into 44 P-IABP and 15 R-IAPB patients who underwent a protected PCI with an IABP. Exclusion criteria were patients with a cardiogenic shock at baseline, an Impella-pump® or an extra corporal membrane oxygenator (ECMO). Both elective and emergency patients were included.

Results: Both groups showed no significant difference in the baseline characteristics. The achieved syntax score reduction after PCI (SYNTAX before PCI – SYNTAX post 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 high sensitive Troponin T (hsTNT) peak values in the P-IAPB group after the intervention (2223.33 ng/L ± 3129.77 ng/L vs. 5823.85 ng/L ± 3885.35ng/L, p = 0.001). The 30-day mortality rates were not significantly different (p= 0.88).

Conclusion: Patients in the prophylactic IAPB group experienced a more complete revascularization measured with the delta SYNTAX score compared to those in the rescue IAPB. Moreover, periinterventional infarct size measured by hsTNT release was significantly lower. Both findings indicate that a prophylactic IAPB implantation in high risk PCI should be preferred to rescue IAPB use.

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