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Intra-Aortic Balloon Pump Counterpulsation during Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction and Cardiogenic Shock: Insights from the British Columbia Cardiac Registry

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  • M Bilal Iqbal
  • Simon D Robinson
  • Lillian Ding
  • Anthony Fung
  • Eve Aymong
  • Albert W Chan
  • Steven Hodge
  • Anthony Della Siega
  • Imad J Nadra
  • British Columbia Cardiac Registry Investigators

Abstract

Background: Cardiogenic shock complicating ST-elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality. In the primary percutaneous coronary intervention (PPCI) era, randomized trials have not shown a survival benefit with intra-aortic balloon pump (IABP) therapy. This differs to observational data which show a detrimental effect, potentially reflecting bias and confounding. Without robust and valid risk adjustment, findings from non-randomized studies may remain biased. Methods: We compared long-term mortality following IABP therapy in patients with cardiogenic shock undergoing PPCI during 2008–2013 from the British Columbia Cardiac Registry. We addressed measured and unmeasured confounding using propensity score and instrumental variable methods. Results: A total of 12,105 patients with STEMI were treated with PPCI during the study period. Of these, 700 patients (5.8%) had cardiogenic shock. Of the patients with cardiogenic shock, 255 patients (36%) received IABP therapy. Multivariable analyses identified IABP therapy to be associated with increased mortality up to 3 years (HR = 1.67, 95% CI:1.20–2.67, p

Suggested Citation

  • M Bilal Iqbal & Simon D Robinson & Lillian Ding & Anthony Fung & Eve Aymong & Albert W Chan & Steven Hodge & Anthony Della Siega & Imad J Nadra & British Columbia Cardiac Registry Investigators, 2016. "Intra-Aortic Balloon Pump Counterpulsation during Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction and Cardiogenic Shock: Insights from the British Columbia Cardiac Re," PLOS ONE, Public Library of Science, vol. 11(2), pages 1-14, February.
    • Handle: RePEc:plo:pone00:0148931
    DOI: 10.1371/journal.pone.0148931
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    References listed on IDEAS

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    1. Brookhart M. Alan & Schneeweiss Sebastian, 2007. "Preference-Based Instrumental Variable Methods for the Estimation of Treatment Effects: Assessing Validity and Interpreting Results," The International Journal of Biostatistics, De Gruyter, vol. 3(1), pages 1-25, December.
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