Safety of intraaortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock

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Abstract Background Cardiogenic shock (CS) complicating acute myocardial infarction (AMI) is a complex disease process which portends poor prognosis and increased risk for morbidity and mortality. Although intraaortic balloon counterpulsation (IABP) is frequently used in the treatment of cardiogenic shock, the safety of this treatment compared to medical therapy remains unclear. Aim The goal of this meta-analysis is to evaluate the safety of IABP compared to medical therapy in patients presenting with AMI-CS. Methods A database search was performed for studies reporting on the association of IABP compared to medical therapy with safety outcomes in patients with AMI-CS. The endpoints of interest were occurrence of ischemic cerebrovascular accidents (CVAs) and moderate to severe bleeding events. The databases searched included Pubmed, Web of Science, and Embase. The search was not restricted by time or publication status. Registry studies were excluded from this analysis. To assess for temporal changes in treatment, subgroup analysis was performed based on studies conducted before 2000 and studies conducted after 2000. Results A total of 4 studies with 1008 participants (418 treated with IABP, 590 treated with medical therapy) met inclusion criteria. Mean age was 67 years old, 67.2% were men, mean follow-up was 7.8 months (ranging 1-12 months). In patients with AMI-CS, treatment with IABP was not associated increased risk of ischemic CVAs (OR 1.81, 95% CI 0.56-5.86; p=0.32). The heterogeneity was low (I2=0%). There was no subgroup differences noted between studies conducted before and after 2000. Use of IABP was associated with significantly higher risk of moderate to severe bleeding compared to medical therapy (OR 7.26, 95% CI 2.66-19.79; p<0.01). The heterogeneity was low (I2=0%). Conclusions Use of IABP compared to medical therapy in patients with AMI-CS is not associated with increased risk of ischemic CVAs but is associated with increased risk of moderate to severe bleeding. Given these findings, the risks of IABP use must be weighed against its clinical benefits in treatment of patients with AMI-CS.Safety events of IABP vs medical therapy

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