title: Use and impact of intra-aortic balloon pump on mortality in patients with acute myocardial infarction complicated by cardiogenic shock: results of the Euro Heart Survey on PCI.
abstract: OBJECTIVE
  The intra-aortic balloon pump (IABP) is recommended by current guidelines as adjunct in patients with cardiogenic shock, despite the lack of larger clinical trials. We sought to investigate the use and impact on mortality of IABP in current practice of percutaneous coronary interventions in Europe.
  
  
  RESULTS
  Between May 2005 and April 2008 a total of 47,407 consecutive patients undergoing percutaneous coronary intervention (PCI) in 176 centres in 33 countries in Europe and the Mediterranean basin were enrolled into the registry. From these, 8,102 had ST-elevation myocardial infarction and 7,999 non-ST elevation myocardial infarction and cardiogenic shock was observed in 7.9% and 2.1%, respectively. Of the 653 patients with cardiogenic shock 25% were treated with an IABP. In-hospital mortality, with and without IABP, was 56.9% and 36.1%. In the multivariate analysis the use of IABP was not associated with an improved survival (odds ratio 1.47; 95% CI 0.97-2.21, p=0.07).
  
  
  CONCLUSIONS
  In current clinical practice in Europe, IABP is used only in one quarter of patients with cardiogenic shock treated with primary PCI. However, there was no hint of a beneficial effect of IABP on outcome. Therefore, a large randomised clinical trial is urgently needed to define the role of IABP in patients with PCI for shock.
authors.affiliation: Herzzentrum Ludwigshafen, Ludwigshafen, Germany. Uwe.Zeymer@t-online.de
authors.forename: Uwe
authors.initials: U
authors.lastname: Zeymer
authors.forename: Timm
authors.initials: T
authors.lastname: Bauer
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Franz
authors.initials: F
authors.lastname: Weidinger
authors.forename: Ricardo
authors.initials: R
authors.lastname: Seabra-Gomes
authors.forename: Matthias
authors.initials: M
authors.lastname: Hochadel
authors.forename: Jean
authors.initials: J
authors.lastname: Marco
authors.forename: Anselm
authors.initials: A
authors.lastname: Gitt
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome