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In-Hospital Mortality in Patients Presenting Cardiogenic Shock After Myocardial Infarction: Does it Benefit Using an Intra-Aortic Balloon Pump?

Fernando Arturo Effio Solis et al. Adriana Brentegani Marcelo Luiz Campos Vieira

Cardiogenic shock (CS) represents a severe clinical syndrome characterized by systemic hypoperfusion and insufficient cardiac output due to primary cardiac dysfunction. Its mortality often exceeds 40%^, of cases, being a highly complex cardiological condition. The etiology is multifactorial, with acute myocardial infarction (AMI) being the predominant cause, responsible for around 30% of cases. Other relevant conditions include acute decompensation of chronic heart failure and cases of acute myocardial dysfunction without a previous history of heart failure, as observed in myocarditis.

The management of post-AMI CS requires a comprehensive approach, which combines early revascularization and hemodynamic support.^– In this context, devices such as the intra-aortic balloon pump (IABP) have their role due to their ability to increase diastolic pressure in the aorta and reduce left ventricular afterload. These physiological effects result in improved coronary perfusion and reduced myocardial oxygen consumption.

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Artigo Original

The use of preoperative intra-aortic balloon in myocardial revascularization surgery associated to severe ventricular dysfunction

Marcelo Kern et al. João Ricardo M. Santanna

OBJECTIVE: To evaluate the effectiveness of prophylactic intra-aortic balloon (IAB) in elective myocardial revascularization surgery (MRS), to prevent trans or post-operative infarction and reduce intra-hospital mortality in patients with low left ventricular ejection fraction. METHODS: Using a cohort study model, 239 patients with left ventricular ejection fraction <40%, submitted to elective MRS with extracorporeal circulation (ECC) were evaluated from March 1995 to February 2001. RESULTS: Of these, 58 patients received preoperative IAB and the remainder underwent surgery without circulatory assistance (control group). The two groups of patients had similar characteristics regarding factors associated to the pertaining outcomes. There were five demises (8.6%) in the group with IAB and 21 (11.6%) in the control group (non-significant difference). There were 2 (3.4%) infarctions in the IAB group and 28 (15.5%) in the control group (p< 0.05), relative risk of 0.22 with an interval of confidence of 95% from 0.05 to 0.85 CONCLUSION: The use of pre-operative IAB can significantly reduce the risk of trans or post-operative acute myocardial infarction (AMI) in patients with decreased systolic function, without increasing vascular complications. In this same situation, the IAB does not significantly decrease mortality. Randomized studies are necessary to establish more precise conclusions.

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In-Hospital Mortality in Patients Presenting Cardiogenic Shock After Myocardial Infarction: Does it Benefit Using an Intra-Aortic Balloon Pump?

The use of preoperative intra-aortic balloon in myocardial revascularization surgery associated to severe ventricular dysfunction

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)