Intra-aortic balloon counterpulsation: impact on patient hemodynamics in acute myocardial infarction complicated by cardiogenic shock

Introduction

Evaluation of hemodynamics in patients with acute myocardial infarction (AMI) is crucial. Hemodynamic changes during intra-aortic balloon counterpulsation (IABC) are monitored using invasive methods for assessment of hemodynamics in patients with cardiogenic shock (CS).

Objective

To evaluate hemodynamic indices in patients with AMI, complicated by CS and managed with IABC during initial days of treatment.

Methods

Hemodynamic indices including cardiac output (CO), cardiac index (CI), mean pulmonary artery pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) were measured by pulmonary artery catheterization using an intermittent thermo-dilution technique for patients with AMI complicated by CS, admitted within 12 hours from the onset of pain and managed by IABC. All measurements were performed within 48 hours after initiation of IABC.

Results

Twenty-nine patients were investigated according to the study protocol: 15 (51.7%) men and 14 (48.3%) women. Average age was 71.4 ± 6.9 years. Anterior AMI was diagnosed for 19 (65.5%) patients, and inferior in 10 (34.5%) patients. Primary percutaneous transluminal coronary angioplasty (PTCA) was successfully performed for 22 (75.9%) patients, primary PTCA was unsuccessful for four (13.8%) patients, and seven (24.1%) patients underwent scheduled cardiac surgery within the first 2 weeks. The inhospital mortality rate was 41.4% (12 patients). The initial (after initiation of IABC) CO was 3.7 ± 1.2 l/min, CI was 1.9 ± 0.7 l/min/m², MPAP was 30 ± 7.1 mmHg (maximum 43 mmHg), PCWP was 19.1 ± 5.1 mmHg (maximum 26 mmHg). After the first 24 hours of IABC, the CO was 3.8 ± 1.6 l/min, CI was 2 ± 0.9 l/min/m², MPAP was 23.7 ± 7.1 mmHg (maximum 36 mmHg), PCWP was 16.8 ± 4 mmHg (maximum 24 mmHg). After 48 hours of IABC, CO was 4.1 ± 1.7 l/min, CI was 2.1 ± 0.8 l/min/m², MPAP was 23.8 ± 6.5 mmHg (maximum 44 mmHg), PCWP was 16.8 ± 4.6 mmHg (maximum 24 mmHg).

Conclusion

Intra-aortic balloon counterpulsation has a positive impact on hemodynamic changes of patients with acute myocardial infarction complicated by cardiogenic shock during the initial days of treatment.