In patients with myocardial infarction–related cardiogenic shock (MI-CS), intra-aortic balloon pump (IABP) use was not associated with improved survival but was linked to higher in-hospital complications. Cardiogenic shock remains the leading cause of in-hospital death in myocardial infarction, highlighting the need to evaluate real-world treatment strategies.

This prospective observational analysis, published in Coronary Artery Disease, evaluated the association between IABP use and 30-day mortality and in-hospital complications. Data were obtained from the Swedish Coronary Angiography and Angioplasty Registry and included all percutaneous coronary intervention (PCI) procedures performed across 31 hospitals in Sweden between 2005 and 2018. A total of 2,991 patients with myocardial infarction (MI) complicated by cardiogenic shock (CS) were included, of whom 737 (25%) received IABP. Instrumental variable analysis using hospital treatment preference was applied to account for baseline differences.

At 30 days, mortality was 52%, increasing to 63.2% at 1 year, while in-hospital complications occurred in 13.4% of patients. IABP use was not associated with reduced mortality at 30 days (risk reduction: −1.1% [95% confidence interval (CI): −15.7 to 13.5; P=0.881]) or at 1 year (risk reduction: −0.8% [95% CI: −23.2 to 0.06; P=0.258]). However, use of IABP was associated with a significantly higher risk of in-hospital complications (increase: 26.1% [95% CI: 15.2 to 36.8; P<0.001]).

These findings support current guideline recommendations discouraging routine IABP use in myocardial infarction–related cardiogenic shock and reinforce the need to reassess its role in clinical practice.