Clinical Research in Cardiology

, Volume 102, Issue 3, pp 223–227 | Cite as

Intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: results of the ALKK-PCI registry

  • Uwe Zeymer
  • Mathias Hochadel
  • Karl-Eugen Hauptmann
  • Klaus Wiegand
  • Burghard Schuhmacher
  • Johannes Brachmann
  • Anselm Gitt
  • Ralf Zahn
Original Paper



The recommendation for the use of the intra-aortic balloon pump (IABP) as adjunct in patients with cardiogenic shock undergoing primary PCI in current guidelines is controversial. We sought to investigate the use and impact of the outcome of IABP in current practice of percutaneous coronary interventions in Germany.

Methods and results

Between January 2006 and December 2011, a total of 55,008 consecutive patients with acute coronary syndromes undergoing PCI in 41 hospitals were enrolled into the prospective Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte registry. Of these, 22,039 had STEMI and 32,969 had NSTEMI, and cardiogenic shock was observed in 1,435 (6.5 %) and 478 (1.4 %), respectively. Of the total of 1,913 patients with shock, 487 (25.5 %) were treated with IABP. In-hospital mortality with and without IABP was 43.5 and 37.4 %. In the multivariate analysis, the use of IABP was associated with a strong trend for an increased mortality (odds ratio 1.45, 95 % CI 1.15–1.84).


In the current clinical practice in Germany, IABP is used only in one quarter of patients with cardiogenic shock treated with primary PCI. We observed no benefit of IABP on outcome, which supports the findings of the randomized IABP-Shock II trial.


Percutaneous coronary intervention Cardiogenic shock Hospital mortality Intra-aortic balloon pump 


  1. 1.
    Goldberg RJ, Samad NA, Yarzebski J, Gurwitz J, Bigelow C, Gore JM (1999) Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med 340:1162–1168PubMedCrossRefGoogle Scholar
  2. 2.
    Hochman JS, Sleeper LA, Webb JG et al (1999) Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 341:625–634PubMedCrossRefGoogle Scholar
  3. 3.
    Zeymer U, Vogt A, Zahn R, Weber MA, Tebbe U, Gottwik M, Bonzel T, Senges J, Neuhaus KL (2004) Predictors of in-hospital mortality in 1333 patients with acute myocardial infarction complicated by cardiogenic shock treated with primary percutaneous coronary intervention (PCI). Eur Heart J 25:322–328PubMedCrossRefGoogle Scholar
  4. 4.
    Moulopoulos S, Stamatelopoulos S, Petrou P (1986) Intraaortic balloon assistance in intractable cardiogenic shock. Eur Heart J 7:396–403PubMedGoogle Scholar
  5. 5.
    Van de Werf F, Bax J, Betriu A et al (2008) Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 23:2909–2945Google Scholar
  6. 6.
    Sjauw KD, Engstrom AE, Vis MM et al (2009) A systematic review and meta-analysis of intra aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J 30:459–468PubMedCrossRefGoogle Scholar
  7. 7.
    Werdan K, Russ M, Buerke M et al (2011) Deutsch-österreichische S3 Leitlinie: infarktbedingter kardiogener Schock—Diagnose, Monitoring und Therapie. Kardiologe 5:166–224Google Scholar
  8. 8.
    Neuhaus KL (1996) Qualitätssicherung bei Koronararteriendilatation. Dt Ärztebl 93:2642–26444Google Scholar
  9. 9.
    Zeymer U, Zahn R, Hochadel M et al (2005) Indikationen und Komplikationen bei Herzkatheterdiagnostik und percutaner coronarer Intervention im Jahr 2003. Ergebnisse des Qualitätssicherungs-Registers der Arbeitsgemeinschaft Leitende kardiologische Krankenhausärzte (ALKK). Z Kardiol 94:392–398PubMedCrossRefGoogle Scholar
  10. 10.
    Jeger RV, Harkness SM, Ramanathan K et al (2006) Emergency revascularization in patients with cardiogenic shock on admission: a report from the SHOCK trial and registry. Eur Heart J 27:664–670PubMedCrossRefGoogle Scholar
  11. 11.
    Hollenberg SM (2004) Recognition and treatment of cardiogenic shock. Semin Respir Crit Care Med 25:661–671PubMedCrossRefGoogle Scholar
  12. 12.
    Babaev A, Frederick PD, Pasta DJ et al (2005) Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA 294:448–454PubMedCrossRefGoogle Scholar
  13. 13.
    Barron HV, Every NR, Parsons LS et al (2001) The use of intra-aortic balloon counterpulsation in patients with cardiogenic shock complicating acute myocardial infarction: data from the National Registry of Myocardial Infarction 2. Am Heart J 14:933–939CrossRefGoogle Scholar
  14. 14.
    Stone GW, Ohman EM, Miller MF et al (2003) Contemporary utilization and outcomes of intra-aortic balloon counterpulsation in acute myocardial infarction: the benchmark registry. J Am Coll Cardiol 4:1940–1945CrossRefGoogle Scholar
  15. 15.
    Prodzinsky R, Lemm H, Swyter M et al (2010) Intra-aortic balloon counterpulsation in patients withacute myocardial infarction complicated by cardiogenic shock—the prospective, randomised iabp shock trial for attenuation of multi-organ dysfunction syndrome. Crit Care Med 38:152–160CrossRefGoogle Scholar
  16. 16.
    Stone GW, Marsalese D, Brodie BR et al (1997) A prospective, randomized evaluation of prophylactic intraaortic balloon counterpulsation in high risk patients with acute myocardial infarction treated with primary angioplasty. Second primary angioplasty in myocardial infarction (PAMI-II) trial investigators. J Am Coll Cardiol 29(7):1459–1467PubMedCrossRefGoogle Scholar
  17. 17.
    Patel M, Smalling R, Thiele H et al (2011) Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock. JAMA 306:1329–1337PubMedCrossRefGoogle Scholar
  18. 18.
    Nanas JN, Moulopoulos SD (1994) Counterpulsation: historical background, technical improvements, hemodynamic and metabolic effects. Cardiology 84:156–167PubMedCrossRefGoogle Scholar
  19. 19.
    Ohman EM, Hochman JS (2001) Aortic counterpulsation in acute myocardial infarction: physiologically important but does the patient benefit? Am Heart J 141:889–892PubMedCrossRefGoogle Scholar
  20. 20.
    Zeymer U, Bauer T, Hamm CW et al (2011) Use and impact of intra-aortic balloon pump on mortality in patients with acute myocardial infarction complicated by cardiogenic shock: results of the Euro Heart Survey on PCI. EuroIntervention 7:437–441PubMedCrossRefGoogle Scholar
  21. 21.
    Curtis JP, Rathore SS, Wang Y et al (2012) Use and effectiveness of intra-aortic balloon pumps among patients undergoing high risk percutaneous coronary intervention: insights from the National Cardiovascular Data Registry. Circ Cardiovasc Qual Outcomes 5:21–30PubMedCrossRefGoogle Scholar
  22. 22.
    Thiele H, Zeymer U, Neumann F et al (2012) Intraaortic balloon support for myocardial infarctioncomplicated by cardiogenic shock. N Engl J Med 367(14):1287–1296PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Uwe Zeymer
    • 1
    • 2
  • Mathias Hochadel
    • 2
  • Karl-Eugen Hauptmann
    • 3
  • Klaus Wiegand
    • 6
  • Burghard Schuhmacher
    • 4
  • Johannes Brachmann
    • 5
  • Anselm Gitt
    • 1
    • 2
  • Ralf Zahn
    • 1
  1. 1.Klinikum Ludwigshafen, Medizinische Klinik BLudwigshafenGermany
  2. 2.Institut für Herzinfarktforschung LudwigshafenLudwigshafenGermany
  3. 3.Krankenhaus der Barmherzigen BrüderTrierGermany
  4. 4.Westpfalz Klinikum, Klinik für Innere MedizinKaiserslauternGermany
  5. 5.Klinikum Coburg, Medizinische Klinik IICoburgGermany
  6. 6.Chirurgische Praxis BraunschweigBraunschweigGermany

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