Abstract 2008: The prospective, randomised IABP SHOCK Trial - Hemodynamic Effects of Intraaortic Balloon Counterpulsation in Patients With Acute Myocardial Infarction complicated by Cardiogenic Shock
Objectives: Intraaortic balloon pump (IABP) counterpulsation is part of the treatment in patients with cardiogenic shock complicating myocardial infarction. It is used to improve cardiac function, reduce peripheral resistance, and augment coronary, cerebral and renal flow. However, there is only limited prospective randomized data for the efficacy of IABP treatment in these patients. Therefore we conducted the IABP Shock Trial as a prospective, randomized, monocentric clinical trial, to determine the hemodynamic effects of additional IABP treatment in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock.
Methods. Cardiac catheterization was performed in 40 patients with acute myocardial infarction complicated by cardiogenic shock, within 12 h of onset of hemodynamic instability. Serial hemodynamic parameters were determined over the next 4 days and compared to patients receiving only medical treatment and those treated with additional intraaortic counterpulsation.
Results. In the medically treated group (no IABP) serial cardiac output documented a -significant increase from day 0 to day 4 (from 4.9 ± 0.3 l/min to 6.7 ± 0.7 l/min). Similar was the rise of cardiac output in patients treated with IABP (from 4.7 ± 0.4 l/min to 6.3 ± 0.4 l/min). However, there was no significant difference between both groups. Pulmonary capillary wedge pressure showed no significant reduction over time and there was no significant difference between both groups. Systemic vascular resistance (SVR) decreased in both groups but did not significantly differ. Further, we were unable to demonstrate a significant differences in cardiac power (CP) for both treatments of the 96 hour period.
Conclusions. Additional IABP treatment did not result in a significant hemodynamic improvement compared to medical therapy alone. Interestingly, even the prognosis validated cardiac power did not show any significant difference. Nevertheless, IABP treatment did not show any harm. Our hemodynamic results have to be validated in a larger prospective randomized trial.