The Clinical Observation Of Intra-aortic Balloon Pump In Acute Myocardial Infarction Complicated By Cardiogenic Shock

Background:Acute myocardial infarction(AMI)with cardiogenic shock(CS)is a common clinical acute and critical disease,Despite primary percutaneous coronary intervention(PCI)can improve myocardial perfusion and save myocardium,CS remains to be the leading cause of death in patients with AMI.Intra-aortic balloon pump counterpulsation(IABP)is one of left ventricular support devices,which reduce left ventricular afterload,improve coronary perfusion and decrease consumption of myocardial oxygen.IABP can also reduce the incidence of complications and improve the success rate of PCI patients with AMI,Nowadays,the IABP is the most widely used mechanical support device for the treatment of CS complicating AMI.The efficacy of IABP adjunctive to primary PCI has been questioned.Objective: The aim of study was to explore the clinical efficacy of IABP and evaluate the impact of IABP on 30-day mortality of patients with AMI presenting in cardiogenic shock.Methods: This retrospective study included 107 patients with AMI complicated with CS from Aguest 2012 to February 2017 who were treated by primary PCI in department of cardiology in the first Affiliated Hospital of Soochow University.The patients were given routine medicine and inotropic agents,they were divided into two groups according to systolic blood pressure(SBP):A group(80mmHg?SBP<90 mmHg),B group(SBP<80 mmHg).The patients in A group were divided into two groups according to whether supported with IABP.the IABP group(n = 46,received PCI with auxiliary IABP)and the control group(n = 42,only received routine PCI therapy).There was 19 patients in B group who received PCI with auxiliary IABP.The efficacy of IABP on the hemodynamics changes(such as blood pressure,heart rate and urine volume),NT-pro BNP value,left ventricular ejection fraction(LVEF),30-day mortality and complications were compared between two groups.Results:1.Group A:There was no statistical significance in two groups of patients in gender,age,past history,infarction area,blood pressure,blood troponin,renal function,type of myocardial infarction,EF value,NT-proBNP and numbers of pathological coronary vessels,Infarct-related artery(P>0.05).2.Group A:There was no significant difference in SBP,diastolic blood pressure(DBP),heart rate(HR),urine volume,NT-proBNP and EF between IABP group and control group before operation(P> 0.05).The SBP,DBP and urine of IABP group were significantly higher than those of control group(P<0.05)after operation.the HR was significantly lower than the control group,The NT-pro BNP of IABP group in 7 days after operation was significantly lower than the control group,the diffience was statistically significant between them(P <0.05).No significant differences were noted between the two groups in LVEF.3.Group A:There was no significant difference in the 30-day mortality between the IABP group and the control group(39.1% Vs 40.5%,P = 0.609 by log rank test).The results of the subgroup showed no significant benefit of IABP.4.Group B :The blood pressure and the urine output after operation were significantly higher than those before operation,and HR after operation was lower than that before operation(P <0.05).There was no significant difference in the LVEF(P> 0.05)between that after operation and before operation,and the 30-day mortality rate in the B group was 47.4%.Conclusions:1.IABP can improve the hemodynamics parameters and NT-proBNP within a short time,IABP can not reduce LVEF One week after surgery.IABP can not reduce the 30-day mortality in AMI patients complicated with CS(80mmHg?SBP< 90 mmHg).2.IABP combined with PCI in AMI with CS(SBP<80mm Hg)can improve the hemodynamics parameters and NT-proBNP within a short time,IABP can not reduce LVEF One week after surgery,the 30-day mortality was still high.