Contemporary trends in cardiogenic shock: Incidence,intra-aortic balloon pump utilisation and outcomes from the London Heart Attack Group

Abstract

Background:

Cardiogenic shock remains a major cause of morbidity and mortality in patients with ST-segment elevation myocardial infarction. We aimed to assess the current trends in cardiogenic shock management, looking specifically at the incidence, use of intra-aortic balloon pump therapy and outcomes in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

Methods and results:

We undertook an observational cohort study of 21,210 ST-segment elevation myocardial infarction patients treated between 2005–2015 at the eight Heart Attack Centres in London, UK. Patients’ details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society percutaneous coronary intervention dataset. There were 1890 patients who presented with cardiogenic shock. The primary outcome was all-cause mortality at a median follow-up of 4.1 years (interquartile range: 2.2–5.8 years). Increasing rates of cardiogenic shock were seen over the course of the study with consistently high mortality rates of 45–70%. A total of 685 patients underwent intra-aortic balloon pump insertion during primary percutaneous coronary intervention for cardiogenic shock with decreasing rates over time. Those patients undergoing intra-aortic balloon pump therapy were younger, more likely to have poor left ventricular function and less likely to have had previous percutaneous coronary intervention compared to the control group. Procedural success rates were similar (86.0% vs 87.1%, p=0.292) although crude, in-hospital major adverse cardiac event rates were higher (43.8% vs 33.7%, p<0.0001) in patients undergoing intra-aortic balloon pump therapy. Kaplan-Meier analysis demonstrated significantly higher mortality rates in patients receiving intra-aortic balloon pump therapy (50.9% intra-aortic balloon pump vs 39.9% control, p<0.0001) during the follow-up period. After multivariate Cox analysis (hazard ratio 1.04, 95% confidence interval 0.62–1.89) and the use of propensity matching (hazard ratio: 1.29, 95% confidence interval: 0.68–1.45) intra-aortic balloon pump therapy was not associated with mortality.

Conclusion:

Cardiogenic shock treated by percutaneous coronary intervention is increasing in incidence and remains a condition associated with high mortality and limited treatment options. Intra-aortic balloon pump therapy was not associated with a long-term survival benefit in this cohort and may be associated with increased early morbidity.

Keywords

Primary percutaneous coronary intervention cardiogenic shock intra-aortic balloon pump therapy myocardial infarction

Get full access to this article

View all access options for this article.

References

Keeley

Boura

Grines

CL.

Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review of 23 randomised trials. Lancet 2003; 361: 13–20.

Chan

Stub

Clark

et al . Usefulness of transient and persistent no reflow to predict adverse clinical outcomes following percutaneous coronary intervention. Am J Cardiol 2012; 109: 478–485.

Goldberg

Spencer

Gore

et al . Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: A population-based perspective. Circulation 2009; 119: 1211–1219.

Aissaoui

Puymirat

Tabone

et al . Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: A report from the USIK 1995, USIC 2000, and FAST-MI French nationwide registries. Eur Heart J 2012; 33: 2535–2543.

Patel

Shivaraju

Fonarow

et al . Temporal trends in the use of intraaortic balloon pump associated with percutaneous coronary intervention in the United States, 1998–2008. Am Heart J 2014; 168: 363–73.e12.

Sjauw

Engstrom

Vis

et al . 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 2009; 30: 459–468.

Cheng

den Uil

Hoeks

et al . Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: A meta-analysis of controlled trials. Eur Heart J 2009; 30: 2102–2108.

Ahmad

Sen

Shun-Shin

et al . Intra-aortic balloon pump therapy for acute myocardial infarction: A meta-analysis. JAMA Intern Med 2015; 175: 931–939.

Barron

Every

Parsons

et al . 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 2001; 141: 933–939.

10.

Patel

Smalling

Thiele

et al . Intra-aortic balloon counterpulsation and infarct size in patients with acute anterior myocardial infarction without shock: The CRISP AMI randomized trial. JAMA 2011; 306: 1329–1337.

11.

Stone

Marsalese

Brodie

et al . 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 1997; 29: 1459–1467.

12.

Thiele

Zeymer

Neumann

et al . Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): Final 12 month results of a randomised, open-label trial. Lancet 2013; 382: 1638–1645.

13.

Thiele

Zeymer

Neumann

et al . Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012; 367: 1287–1296.

14.

van ‘t Hof

Liem

de Boer

et al . A randomized comparison of intra-aortic balloon pumping after primary coronary angioplasty in high risk patients with acute myocardial infarction. Eur Heart J 1999; 20: 659–665.

15.

O’Gara

Kushner

Ascheim

et al . 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127: e362–e425.

16.

Windecker

Kolh

Alfonso

et al . 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35: 2541–2619.

17.

Ludman

PF.

British Cardiovascular Intervention Society Registry for audit and quality assessment of percutaneous coronary interventions in the United Kingdom. Heart 2011; 97: 1293–1297.

18.

Kunadian

Qiu

Ludman

et al . Outcomes in patients with cardiogenic shock following percutaneous coronary intervention in the contemporary era: An analysis from the BCIS database (British Cardiovascular Intervention Society). JACC: Cardiovasc Interv 2014; 7: 1374–1385.

19.

Goldberg

Samad

Yarzebski

et al . Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med 1999; 340: 1162–1168.

20.

Kolte

Khera

Aronow

et al . Trends in incidence, management, and outcomes of cardiogenic shock complicating ST-elevation myocardial infarction in the United States. J Am Heart Assoc 2014; 3: e000590.

21.

Jeger

Radovanovic

Hunziker

et al . Ten-year trends in the incidence and treatment of cardiogenic shock. Ann Intern Med 2008; 149: 618–626.

22.

Kern

Aguirre

Bach

et al . Augmentation of coronary blood flow by intra-aortic balloon pumping in patients after coronary angioplasty. Circulation 1993; 87: 500–511.

23.

Williams

Korr

Gewirtz

et al . The effect of intraaortic balloon counterpulsation on regional myocardial blood flow and oxygen consumption in the presence of coronary artery stenosis in patients with unstable angina. Circulation 1982; 66: 593–597.

24.

Davidson

Baumgariner

Omari

et al . Intra-aortic balloon pump: Indications and complications. J Natl Med Assoc 1998; 90: 137–140.

25.

Unverzagt

Buerke

de Waha

et al . Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev 2015; 3: CD007398.

26.

Ouweneel

Eriksen

Sjauw

et al . Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol 2017; 69: 278–287.

27.

Steg

James

Atar

et al . ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012; 33: 2569–2619.

28.

Sanborn

Sleeper

Bates

et al . Impact of thrombolysis, intra-aortic balloon pump counterpulsation, and their combination in cardiogenic shock complicating acute myocardial infarction: A report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK? J Am Coll Cardiol 2000; 36: A1123–A1129.

29.

Khashan

Pinsky

MR.

Does intra-aortic balloon support for myocardial infarction with cardiogenic shock improve outcome?

Crit Care 2013; 17: 307.

30.

Bergh

Angeras

Albertsson

et al . Does the timing of treatment with intra-aortic balloon counterpulsation in cardiogenic shock due to ST-elevation myocardial infarction affect survival? Acute Card Care 2014; 16: 57–62.

31.

Cohen

Urban

Christenson

et al . Intra-aortic balloon counterpulsation in US and non-US centres: Results of the Benchmark Registry. Eur Heart J 2003; 24: 1763–1770.

32.

Zeymer

Bauer

Hamm

et al . 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 2011; 7: 437–441.

33.

Sandhu

McCoy

Negi

et al . Use of mechanical circulatory support in patients undergoing percutaneous coronary intervention: Insights from the National Cardiovascular Data Registry. Circulation 2015; 132: 1243–1251.

34.

Lauten

Engstrom

Jung

et al . Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: Results of the Impella-EUROSHOCK registry. Circ Heart Fail 2013; 6: 23–30.

35.

Seyfarth

Sibbing

Bauer

et al . A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol 2008; 52: 1584–1588.

36.

Cheng

Hachamovitch

Kittleson

et al . Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: A meta-analysis of 1866 adult patients. Ann Thorac Surg 2014; 97: 610–616.

37.

Burkhoff

Cohen

Brunckhorst

et al . A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. Am Heart J 2006; 152: 469.e1–e8.

38.

Thiele

Sick

Boudriot

et al . Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 2005; 26: 1276–1283.

39.

Roffi

Patrono

Collet

et al . 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2016; 37: 267–315.

40.

British Cardiovascular Intervention Society (BCIS). Audit returns 2015 – summary presentation at ACI 2017, https://www.bcis.org.uk/education/adult-interventional-procedures/ (accessed 10 May 2017).