Clinical Analysis For The Use Of Intra-aortic Balloon Counterpulsation Combined With Percutaneous Coronary Intervention For Acute Myocardial Infarction Patients With Cardiogenic Shock

Background:The intra-aortic balloon counterpulsation (IABP) is widely used to provide circulatory support for patients of myocardial infarction complicating cardiogenic shock combining with percutaneous coronary intervention (PCI). The clinical efficacy, the risk factors of mortality and the risk factors of IABP-related complications are still uncertain while using IABP in combination with PCI in patients with AMI complicated by CS.Purpose:To explore the efficacy and safety of applying IABP combined with PCI in patients with AMI complicating CS. To analyze the factors related to30-day mortality in these patients.Objective:Patients applied IABP combined with PCI with AMI complicating CS in Sir Run Run Shaw hospital, medical afflicted hospital of college medicine Zhejiang University between2009and2014.Methods:Retrospectively investigated36patients (72.2%men,27.8%women, mean age69.03±12.865years) applied IABP combined with PCI with AMI complicating CS in Sir Run Run Shaw Hospital. The clinical characteristics, risk factors, EEG characteristics, coronary angiographic features, PCI results, hemodynamic indexes, IABP-related complications, and clinical outcomes are recorded for analysis.Results:Compared with the systolic pressure of87.11±20.470mmHg, diastolic pressure of56.22±14.955mmHg, mean arterial pressure of66.52±15.706mmHg before IABP, application of IABP combined with PCI made an advance in hemodynamics, as systolic pressure of97.50±18.932mmHg, diastolic pressure of65.31±12.651mmHg, mean arterial pressure of75.58±12.775mmHg1hour later, and systolic pressure of96.75±22.125mmHg, diastolic pressure of67.56±24.723mmHg, mean arterial pressure of77.29±20.927mmHg24hours later, P<0.05. The heart rate decreased from117.39±33.232b/min before IABP to92.42±17.457b/min24hours later, P<0.05.10patients died during hospitalization, the in-hospital mortality was27.8%,60%died of cardiogenic shock.16patients died during30days, the30-day mortality was44.4%,62.5%died of cardiogenic shock.4patients got IABP associated complications, with the incidence rate of11.1%,1patient got a significant complication, with the incidence rate of2.8%, and IABP-related mortality rate was0%. Multi-factor logistic regression analysis showed the need for mechanical ventilation was a clinical feature of30-day poor prognosis, OR=9.03,95%CI1.104～73.831, P<0.05. Conclusion:Application of IABP combined with PCI treating AMI complicating CS can improve the hemodynamics, but the in-hospital mortality and30-day mortality is still high, mostly cause of cardiogenic shock. The need for mechanical ventilation was a clinical feature of30-day poor prognosis. Application of IABP is safe with acceptable complication incidence.