Intra-aortic balloon support for myocardial infarction with cardiogenic shock: insights from the Swedish Coronary Angiography and Angioplasty Registry

Background Cardiogenic shock remains the leading cause of in-hospital death in patients with acute myocardial infarction (MI). The intra-aortic balloon pump (IABP), once widely used, was downgraded in European guidelines after a major randomized trial showed no mortality benefit. This prospective observational study evaluated the impact of IABP on 30-day mortality and in-hospital complications in real-world patients with MI complicated by cardiogenic shock. Methods Data were obtained from the Swedish Coronary Angiography and Angioplasty Registry, including all percutaneous coronary intervention procedures performed across 31 hospitals in Sweden between 2005 and 2018. A total of 2991 patients with cardiogenic shock were included, of whom 737 (25%) received IABP. To account for baseline differences, instrumental variable analysis was applied using hospital treatment preference as the instrument. Results At 30 days, 52% of patients had died, and by 1 year, mortality reached 63.2%. In-hospital complications occurred in 13.4% of patients. IABP treatment was not associated with reduced mortality at 30 days [risk reduction: −1.1%, 95% confidence interval (CI): −15.7 to 13.5; P = 0.881] or at 1 year (risk reduction: −0.8%, 95% CI: −23.2 to 0.06; P = 0.258). However, IABP use was associated with a significantly higher risk of in-hospital complications (increase of 26.1%, 95% CI: 15.2–36.8; P Conclusion IABP did not improve short- or long-term survival in patients with MI-related cardiogenic shock but was linked to increased complications, supporting current guideline recommendations against its routine use.