Objectives

Patients with cardiogenic shock and left main coronary artery stenosis have an extremely high mortality rate. Sparse evidence for benefit of intra aortic balloon pump implantation (IABP) is present. Our purpose was to establish the possible positive long-term benefit of IABP implantation for patients who underwent emergent angioplasty of left main coronary artery stenosis presented with cardiogenic shock.

Methods

The study included 44 consecutive patients in cardiogenic shock who underwent emergent angioplasty of the left main coronary artery and were followed up clinically. Angioplasty strategy, route of arterial access, pre-dilation devices were at the discretion of the operator. The only goal at the time of index angioplasty was patient’s survival. After eventual patients’ stabilization we tried to treat all significant lesions. Patients were followed from February 2005 through May 2013. They were divided into a group with and without IABP implantation.

24 patients got IABP and 18 did not. Stent diameter was significantly bigger in non IABP group (p=0.022). Otherwise, there was no significant difference between groups regarding age, gender, implanted stent length, drug eluting stents, distal left main stenosis and diabetes. Median follow up time was 167 days (IQR 10 – 862).

We constructed Kaplan-Meier survival curves to determine post-discharge follow-up mortality. Cox proportional hazards regression was used to compute hazard ratios (HRs) as estimates for death. We controlled for age, gender, stent length, stent diameter, multiwessel disease, non-drug eluting stent treatment, additional chronic total occlusion, systolic blood pressure at admission, diabetes, TIMI flow at admission and after angioplasty. Distributions of continuous variables in the 2 groups were compared with the 2-sample t test. Distributions of categorical variables were compared with the chi-square test.