Written by Samuel Rouleau
Spoon Feed
Early intra-aortic balloon pump (IABP) placement for patients with cardiogenic shock from heart failure (HF-CS) is not associated with improved 60-day survival or bridge to heart replacement therapy.
IABPs do not inflate chances of survival in cardiogenic from heart failure
The use of IABPs has been studied in the setting of cardiogenic shock from acute coronary syndrome. This trial addresses the question of IABP implementation in patients with cardiogenic shock in the setting of heart failure (HF-CS). This randomized multicenter trial in Italy included adult patients less then 75 years of age with HF-CS, SCAI classification B – D. Patients were randomized to IABP and standard of care (n=48) vs. standard of care alone (n=53). 6 patients crossed over to the IABP group. The trial was stopped early for futility.
The primary outcome of 60-day survival or successful bridge to heart replacement therapy was achieved for 43 (81%) patients in the IABP group compared to 36 patients (75%) in standard care (HR 0.72; 95%CI 0.31-1.68). 21 patients in IABP and 16 patients receiving standard care were successfully bridged to HRT with no effect seen from IABP implementation. There were no meaningful differences in the secondary outcomes.
How does this change my practice?
This is another trial that does not demonstrate benefit for IABP.
– No studies have shown a consistent benefit to IABPs, though using them in individualized, specific scenarios is reasonable (i.e. mechanical complications from MI, high-risk PCI).
– The trial included SCAI Class B (“beginning” of cardiogenic shock), and early cardiogenic shock often goes underrecognized in the ED, so we should be familiar with this classification schema.
Source
Early Intra-Aortic Balloon Support for Heart Failure-Related Cardiogenic Shock: A Randomized Clinical Trial. J Am Coll Cardiol. 2025 Apr 29;85(16):1587-1597. doi: 10.1016/j.jacc.2025.03.003. Epub 2025 Mar 30. PMID: 40162941
