Abstract 15336: Predictors of Intra-Aortic Balloon Pump Failure in Chronic Heart Failure Complicated With Cardiogenic Shock

• Published in: Circulation (New York, N.Y.) N.Y.), 2018-11, Vol.138 (Suppl_1 Suppl 1), p.A15336-A15336
• Main Authors: Elison, David, Cheng, Richard, Li, Kevin, Kirkpatrick, James, Dardas, Todd, Mahr, Claudius, McCabe, James, Masri, Sofia C
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

BackgroundIABP has shown limited or no clinical benefit in patients with CS complicating acute myocardial infarction. However, there is a paucity of data among patients with chronic heart failure presenting with CS (cardiac index < 2.2 L/min/m2 or need of vasoactive drugs) and their response to IABP. We sought to evaluate hemodynamic and clinical predictors of success in CS patients who require IABP placement.MethodsWe retrospectively data from patients with chronic heart failure at our institution who consecutively underwent IABP implantation for CS from 2015 to 2017. Success of IABP therapy was defined as survival to hospital discharge or bridge to durable support (LVAD or heart transplantation). Failure of IABP was defined as death or refractory CS requiring upgrade to a higher level of temporary support.ResultsOne hundred and thirty one patients with ADHF presenting with CS underwent IABP placement. Overall 30 day failure of IABP occurred in 36.4% of patients. 63.6% recovered from shock and were discharged or were successfully bridged to LVAD. Univariate associations of IABP failure were older age, baseline glomerular filtration rate (GFR), model for end-stage liver disease (MELD) score and mean pulmonary artery pressure. No other pre-implant hemodynamics or echocardiographic metrics were predictive of response. After IABP, the lack of decreased of right atrial pressure and change in cardiac power index (CPI) were associated with failure.ConclusionsAmong patients with chronic systolic heart failure who develop CS, more than one-half of patients stabilized with IABP mainly when use as bridge to LVAD. Baseline MELD score was predictive of poor outcomes, suggesting higher degree of impaired organ perfusion and likely need for higher level of ventricular support. Further studies are needed to refine selection criteria in this population.