title: Use of intraaortic balloon counterpulsation in patients presenting with cardiogenic shock: observations from the GUSTO-I Study. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries.
abstract: OBJECTIVE
  We sought to examine the use, complications and outcomes with early intraaortic balloon counterpulsation (IABP) in patients presenting with cardiogenic shock complicating acute myocardial infarction and treated with thrombolytic therapy.
  
  
  BACKGROUND
  The use of IABP in patients with cardiogenic shock is widely accepted; however, there is a paucity of information on the use of this technique in patients with cardiogenic shock who are treated with thrombolytic therapy.
  
  
  METHODS
  Patients who presented within 6 h of chest pain onset were randomized to one of four thrombolytic regimens. Cardiogenic shock was not an exclusion criterion, and data for these patients were prospectively collected. Patients presenting with shock were classified into early IABP (insertion within one calendar day of enrollment) or no IABP (insertion on or after day 2 or never).
  
  
  RESULTS
  There were 68 (22%) IABP placements in 310 patients presenting with shock. Early IABP use occurred in 62 patients (20%) and none in 248 (80%). Most IABP use occurred in the United States (59 of 68 IABP placements) involving 32% of U.S. patients presenting with shock. Despite more adverse events in the early IABP group and more episodes of moderate bleeding, this cohort showed a trend toward lower 30-day and 1-year mortality rates.
  
  
  CONCLUSIONS
  IABP appears to be underutilized in patients presenting with cardiogenic shock, both within and outside the United States. Early IABP institution is associated with an increased risk of bleeding and adverse events but a trend toward lower 30-day and 1-year all-cause mortality.
authors.affiliation: Duke Clinical Research Institute, Durham, North Carolina, USA. ander040@onyx.mc.duke.edu
authors.forename: R D
authors.initials: RD
authors.lastname: Anderson
authors.forename: E M
authors.initials: EM
authors.lastname: Ohman
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: I
authors.initials: I
authors.lastname: Col
authors.forename: A L
authors.initials: AL
authors.lastname: Stebbins
authors.forename: E R
authors.initials: ER
authors.lastname: Bates
authors.forename: R J
authors.initials: RJ
authors.lastname: Stomel
authors.forename: C B
authors.initials: CB
authors.lastname: Granger
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
mesh_terms: D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D011446:Prospective Studies; D012008:Recurrence; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome