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Predictors of mortality in patients with acute myocardial infarction managed with intra-aortic balloon assistance: a 20-years 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; Marta Catarina Almeida; André Lobo; Daniel Caeiro; Marta Ponte; Marisa Passos Silva; Pedro Gonçalves Teixeira; Adelaide Dias; Pedro Braga; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">Background: </span></span></span></strong><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:black">Intra-aortic balloon (IABP) counterpulsation improves coronary perfusion and decreases left ventricular (LV) workload, thereby enhancing oxygen delivery and stabilizing hemodynamics. While current guidelines primarily recommend its use in patients with mechanical complications of acute myocardial infarction (AMI), some studies suggest clinical benefits in cardiogenic shock, refractory angina, and severe ischemia in the setting of AMI. However, research on mortality predictors in AMI patients treated with IABP is still limited.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">Purpose</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">We sought to evaluate the predictors of in-hospital mortality in patients with AMI implanted with IABP in a tertiary center.</span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">Methods</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">We performed a retrospective single-center cohort study. Patients with AMI who received IABP support between 1 january 2005 and 31 may 2024 were enrolled. Basal characteristics of the population were determined. The sample was divided in 2 groups (g) according to in-hospital mortality: survivors (gA) and non-survivors (gB). Patient’s demographics, comorbidities, clinical characteristics and outcomes were compared. According to the data distribution, appropriate statistical tests were conducted to compare independent samples. Multivariable logistic regression was used to analyze independent predictors of in-hospital mortality. </span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">Results</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">This cohort included 717 patients (mean age 67</span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:#1d1d1d">±</span></span></span><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">12 years, 73.1% male). In-hospital mortality was 24.2% (173 patients). Non-survivors were older (69</span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:#1d1d1d">±</span></span></span><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">12 vs 66</span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:#1d1d1d">±</span></span></span><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">12 years, p=0.011), with higher BMI (28</span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:#1d1d1d">±</span></span></span><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">4 kg/m<sup>2</sup>, p=0.031) and a greater prevalence of diabetes (38.8 vs 30%, p=0.032), HF (28.5 vs 20.4%, p=0.027), valvular disease (9.3 vs 5.2%, p=0.049), and stroke (13.4 vs 5.9%, p=0.001).</span></span></span> <span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:black">They had worse LVEF (severely depressed in 57.8 vs 17.7%, p<0.001), more frequent Killip IV presentation (</span></span></span><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">77.3 vs 34.8%, p<0.001), lower creatinine clearance (47 vs 67 mL/min, p<0.001) and more severe IABP-related complications (11 vs 3%, p<0.001).</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">The length of in-hospital stay was significantly shorter in gB (4 vs 9 days). Cardiogenic shock was the primary indication for IABP in non-survivors (86 vs 26.8%, p<0.001), explaining a higher need of inotropic support (90.7 vs 32.3%, p<0.001 in this group.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">In the multivariate analysis the presence of HF (OR 1.78; CI 1.1-2.89, p=0.002), LEVF (OR 1.18; CI 1.02-1.36, p=0.027), IABP indication (OR 0.37; CI 0.29-0.47, p<0.001), postprocedural TIMI flow grade 3 (OR 0.22; CI 0.09-0.55, p=0.001) and inotropes use (OR 14.45; CI 6.39-32.68, p<0.001) were independent predictors of in-hospital mortality (Table 2).</span></span></span></span></span></p> <p style="text-align:justify"><br /> <span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">Conclusions</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Calibri",sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:"Avenir Book""><span style="color:#1d1d1d">Our study suggest that severely depressed EF, cardiogenic shock, and the need for inotropes are associated with a higher risk of in-hospital mortality, whereas TIMI 3 flow is linked to improved survival. These factors may help identify the patients most likely to benefit from IABP in the context of AMI.</span></span></span></span></span></p>
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