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Paper title Intra-Aortic Balloon Pump in Heart Failure-Related Cardiogenic Shock: A Meta-Analysis of Randomized Clinical Trials
Paper code A04
Authors
  1. Corstiaan den Uil Maasstad Ziekenhuis Speaker
  2. Luca Baldetti IRCCS “San Raffaele” Hospital
Form of presentation Oral abstract presentation
Topics
  • Novel scientific information
Abstract text Background: Heart failure-related cardiogenic shock (HF-CS) is a growing and heterogeneous syndrome characterized by progressive hemodynamic compromise, systemic hypoperfusion, and end-organ dysfunction. Compared to acute myocardial infarction-related shock, HF-CS has distinct pathophysiological features, which may influence response to mechanical circulatory support (MCS). The intra-aortic balloon pump (IABP) has been widely used in HF-CS despite limited randomized evidence.
Methods: We conducted a study-level meta-analysis of RCTs comparing IABP with standard care in adults with HF-CS. The primary endpoint was a composite of survival or successful bridge to heart replacement therapy (HRT) at 60 days. A fixed-effects model was used to pool results. Subgroup analyses were performed based on age, sex, mean arterial pressure, and Society for Cardiovascular Angiography & Interventions (SCAI) CS stage.
Results: Two randomized trials comprising 133 patients (69 IABP, 64 controls) were included. Overall, IABP use was associated with a non-significant trend toward improved 60-day survival or successful bridge to HRT (risk difference [RD] 0.12; 95% CI -0.02–0.27; p=0.096; OR 1.94; 95% CI 0.87–4.32). Substantial heterogeneity was observed (I²=49%). Notably, in patients with SCAI C-D stages, IABP use significantly improved the primary outcome (RD 0.17; 95% CI 0.01–0.34; p=0.040; OR 2.52; 95% CI 1.02–6.23) with low heterogeneity (I²=14%). No significant interaction was found between IABP effect and age, sex, or mean arterial pressure.
Conclusions: This meta-analysis of the only available randomized trials suggests that early IABP support may confer clinical benefit in HF-CS patients, particularly those in advanced (SCAI C-D) stages. While the overall population showed a non-significant trend toward benefit, the significant improvement in SCAI C-D stages underscores the importance of careful patient selection. These findings support the need for larger, adequately powered trials with stricter inclusion criteria to definitively establish the role of IABP in HF-CS management.