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Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2003-.

Cochrane Database of Systematic Reviews: Plain Language Summaries.

Intra‐aortic Balloon counterpulsation in patients with acute myocardial infarction and cardiogenic shock

This version published: 2011; Review content assessed as up-to-date: July 19, 2010.

Plain language summary

Patients with acute myocardial infarction complicated by cardiogenic shock still have a poor prognosis after primary revascularization procedures such as coronary artery bypass grafting or primary percutaneous coronary intervention. Under patho‐physiological considerations, the failing heart due to impaired left ventricular function following acute myocardial infarction is the main cause for the development of cardiogenic shock characterized by instable haemodynamics with reduced systolic and mean arterial pressures. The reduced blood pressure leads to hypoperfusion with reduced oxygen supply to vital organs. Following these pathophysiological considerations it seemed to be a consequent therapeutic concept to give haemodynamic support to these haemodynamically instable patients by a mechanical assist device, called intra‐aortic balloon pump (IABP). While the balloon becomes in‐ and deflated synchronal with the beats of the heart, it acts to increase blood flow to the heart as well as reduce the amount of work the heart is doing. This support can be provided for a few hours and up to several days. Recent evidence suggests that certain patients with acute myocardial infarction complicated by cardiogenic shock and treated by thrombolysis may have a benefit from a period of support with the IABP after revascularization by thrombolysis. Nowadays the most preferred revascularization procedure is primary percutaneous coronary intervention. For these patients a few number of heterogeneous randomised trials with only small patient numbers were not able to show convincing evidence, for either benefit or harm, supporting the use of the intra‐aortic counterpulsation beyond initial haemodynamic improvements. This present lack of evidence due to a small number of randomised controlled trials with small numbers of patients does not exclude, that there might be clinically significant effects, which only can be proven by larger randomised controlled trials. For this reason a larger multicenter trial (IABP‐SHOCK II) has been started in 2009, to clarify the use of the IABP in infarct related cardiogenic shock and its results will  provide better evidence at the beginning of 2013.  


Background: Intra‐aortic balloon pump counterpulsation (IABP) is currently the most commonly used mechanical assist device for patients with cardiogenic shock due to acute myocardial infarction.

Although there is only limited evidence by randomised controlled trials, the current guidelines of the American Heart Association/American College of Cardiology and the European Society of Cardiology strongly recommend the use of the intra‐aortic balloon counterpulsation in patients with infarction‐related cardiogenic shock on the basis of pathophysiological considerations as also non‐randomised trials and registry data.   

Objectives: To determine the effect of IABP versus non‐IABP or other assist devices guideline compliant standard therapy, in terms of efficacy and safety, on mortality and morbidity in patients with acute myocardial infarction complicated by cardiogenic shock.

Search methods: Searches of CENTRAL, MEDLINE and EMBASE, LILACS, IndMed and KoreaMed, registers of ongoing trials and proceedings of conferences were conducted in January 2010, unrestricted by date. Reference lists were scanned and experts in the field contacted to obtain further information. No language restrictions were applied.

Selection criteria: Randomised controlled trials on patients with myocardial infarction complicated by cardiogenic shock.

Data collection and analysis: Data collection and analysis were performed according to a published protocol. Individual patient data were provided for five trials and merged with aggregate data. Summary statistics for the primary endpoints were hazard ratios (HR's) and odds ratios with 95% confidence intervals (CI).

Main results: Six eligible and two ongoing studies were identified from a total of 1410 references. Three compared IABP to standard treatment and three to percutaneous left assist devices (LVAD). Data from a total of 190 patients with acute myocardial infarction and cardiogenic shock were included in the meta‐analysis: 105 patients were treated with IABP and 85 patients served as controls. 40 patients were treated without assisting devices and 45 patients with LVAD. HR's for all‐cause 30‐day mortality of 1.04 (95% CI 0.62 to 1.73) provides no evidence for a survival benefit. While differences in survival were comparable in patients treated with IABP, with and without LVAD, haemodynamics and incidences of device related complications show heterogeneous results.

Authors' conclusions: Available evidence suggests that IABP may have a beneficial effect on the haemodynamics, however there is no convincing randomised data to support the use of IABP in infarct related cardiogenic shock.

Editorial Group: Cochrane Heart Group.

Publication status: New.

Citation: Unverzagt S, Machemer M, Solms A, Thiele H, Burkhoff D, Seyfarth M, de Waha A, Ohman E.M, Buerke M, Haerting J, Werdan K, Prondzinsky R. Intra‐aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD007398. DOI: 10.1002/14651858.CD007398.pub2. Link to Cochrane Library. [PubMed: 21735410]

Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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