European Journal of Emergency Medicine vol:10 issue:3 pages:213-218
OBJECTIVE: To describe the characteristics and mortality rates of 132 cardiogenic shock patients treated with intra-aortic balloon counterpulsation at a university hospital. INTERVENTIONS: All patients underwent intra-aortic balloon counterpulsation. A total of 99 out of 132 patients were revascularized with angioplasty, surgery or were transplanted (intervention group), 33 out of 132 had no further intervention (no-intervention group). MEASUREMENTS AND RESULTS: Overall mortality was 54.5% (72/132). In the intervention group mortality was 50.5% (50/99), in the no-intervention group mortality was 66.6% (22/33). The odds ratio for death comparing the intervention group with the no-intervention group was 0.533 (95% confidence interval 0.238-1.189, P = 0.122). By univariate analysis, diabetes and a left ventricular ejection fraction of less than 0.35 represented an increased odds ratio of death of 4.25 (1.813-9.965, P = 0.001) and 3.03 (1.22-7.54, P = 0.015), respectively. A lactate level greater than 2.5 mg/dl at baseline resulted in an increased odds ratio of death of 5.185 (1.988-13.525, P = 0.0001). Using a multivariate logistic regression analysis, a left ventricular ejection fraction less than 0.35 and diabetes remained significantly correlated with death. CONCLUSION: Mortality rates remain high in cardiogenic shock patients in need of intra-aortic balloon counterpulsation. The odds ratio for death tended to be lower in the intervention group compared with the no-intervention group, although the absolute difference in mortality as a result of an intervention was only 15.2%, and did not reach statistical significance probably because of the small sample size. Diabetes and an ejection fraction lower than 35% are significant predictors for a worse prognosis.