USE OF INTRAAORTIC BALLOON COUNTERPULSATION IN PATIENTS PRESENTING WITH CARDIOGENIC-SHOCK - OBSERVATIONS FROM THE GUSTO-I STUDY

Objectives. We sought to examine the use, complications and outcomes w ith early intraaortic balloon counterpulsation (IABP) in patients pres enting with cardiogenic shock complicating acute myocardial infarction and treated with thrombolytic therapy. Background. The use of IABP in patients with cardiogenic shock is widely accepted; however, there is a paucity of information on the use of this technique in patients wit h cardiogenic shock who are treated with thrombolytic therapy. Methods . Patients who presented within 6 h of chest pain onset were randomize d to one of four thrombolytic regimens, Cardiogenic shock was not an e xclusion criterion, acid data for these patients were prospectively co llected, Patients presenting with shock were classified into early IAB P (insertion within one calendar day of enrollment) or no IABP (insert ion on or after day 2 or never). Results. There were 68 (22%) IABP pla cements in 310 patients presenting with shock, Early IABP use occurred in 62 patients (20%) and none in 248 (80%). Most IABP use occurred in the United States (59 of 68 IABP placements) involving 32% of U.S. pa tients presenting with shock, Despite more adverse events in the early IABP group and more episodes of moderate bleeding, this cohort showed a trend toward lower 30-day and 1-year mortality rates. Conclusions. IABP appears to be underutilized in patients presenting with cardiogen ic shock, both within and outside the United States, Early IABP instit ution is associated with an increased risk of bleeding and adverse eve nts but a trend toward lower 30-day and 1-year all-cause mortality. (C ) 01997 by the American College of Cardiology.