SPC365

Vascular complications in Intra-aortic balloon pump patients: insights from a 20-year single-center experience

Session: SESSÃO DE POSTERS 35 - DOENÇAS CARDIOVASCULARES - CHOQUE CARDIOGÉNICO 1
Speaker: Jéni Quintal

Congress: CPC 2025
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.3 Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care
Session Type: Cartazes
FP Number: ---
Authors: Jéni Quintal; André Lobo; Marta Catarina Almeida; Daniel Caeiro; Marta Ponte; Marisa Passos Silva; Pedro Gonçalves Teixeira; Adelaide Dias; Pedro Braga; Ricardo Fontes-Carvalho
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Background:&nbsp;</span></span></span></strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">Intra-aortic balloon pump (IABP) is a valuable intervention for managing acute myocardial infarction (AMI) in carefully selected patients. However, its broader application is hindered by a significant risk of vascular complications. To enhance patient selection and reduce adverse events, a comprehensive understanding of the clinical predictors of major vascular complications is essential, yet remains limited.</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Purpose</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">We aimed to assess the incidence of vascular complications and to identify predictors of major vascular complications (MVC) in patients with AMI implanted with IABP in a tertiary center.</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Methods</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">We conducted a retrospective single-center cohort study. Patients with AMI who received IABP support between 1 january 2005 and 31 may 2023 were included. Patients with missing data on vascular complications were excluded. Demographic data, comorbidities, clinical characteristics, vascular complications, and outcomes were assessed. The sample was divided into two groups based on the presence (group B) or absence (group A) of MVC. Statistical analyses, including multivariable logistic regression, were used to compare the groups, and identify independent predictors of MVC.</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Results</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">A total of 694 patients were included (73.2% male, mean age 67</span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:#1d1d1d">&plusmn;</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">12 years, mean BMI 27</span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:#1d1d1d">&plusmn;</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">4 kg/m<sup>2</sup>). There was a high prevalence of cardiovascular risk factors and heart failure (Table 1). The main indications for IABP implantation were cardiogenic shock (40.6%) and hemodynamic support until CABG (27.4%). Most patients had severely reduced left ventricle ejection fraction (27.7%).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">The overall rate of MVC rate was 4.8% (n=33), including cases of lower limb ischemia (2.2%), 11 of major hemorrhage (1.6%), 8 vascular lesions requiring vascular surgery (1.2%), and 2 of intra-arterial balloon rupture (0.3%). Minor vascular complications occurred in 7.5% (n=52), with 43 local hematomas (6.2%) and 9 minor hemorrhages (1.3%).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Group B had a higher proportion of severely depressed LVEF (45.5 vs 26.8%, p=0.019) and a trend toward lower creatinine clearance (51 &plusmn; 26 vs 61 &plusmn; 29 mL/min, p=0.193), and greater vasopressor use (73.3 vs. 65.4%, p=0.111). In-hospital mortality was higher in group B (45.5% vs. 23.3%, p=0.004). No differences in-hospital stay or duration of IABP support were observed between the groups.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Multivariate analysis showed that severely depressed EF (OR 2.57; CI 1.8-5.62, p=0.018) and in-hospital mortality (OR 2.23; CI 1.01-4.88, p=0.036) were independently associated with MVC (Table 2).</span></span></span></span></span></p>

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<span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Conclusions</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Major vascular complications were infrequent in AMI patients with IABP support but linked to higher in-hospital mortality. Severely depressed LVEF and in-hospital mortality were independently associated with the complications. These findings underscore the importance of careful patient selection for IABP therapy.</span></span></span></span></span></p>