ArticleBMC cardiovascular disorders2026
Impact of concomitant intra-aortic balloon pump support on outcomes in patients with acute myocardial infarction-related cardiogenic shock undergoing percutaneous coronary intervention with veno-arterial ECMO: a propensity-matched analysis.
Article in BMC cardiovascular disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAcute myocardial infarction-related cardiogenic shock (AMI-CS) remains associated with extremely high mortality in patients with acute myocardial infarction despite timely revascularization and advances in mechanical circulatory support (MCS). Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is increasingly used as rescue therapy during percutaneous coronary intervention (PCI); however, ECMO-related left ventricular overload may compromise myocardial recovery. Whether concomitant intra-aortic balloon pump (IABP) support improves outcomes in this setting remains uncertain.
methodsWe conducted a single-center retrospective cohort study including adult patients with cardiogenic shock undergoing PCI supported with V-A ECMO between January 2020 and December 2025. Patients were stratified according to the use of adjunctive IABP (ECMO-IABP vs. ECMO alone). Propensity score matching (1:1) was performed using age, sex, lactate and VIS before ECMO. The primary endpoint was in-hospital mortality. Secondary outcomes included ECMO weaning success, complications, length of intensive care unit stay and 30-day survival. Survival was assessed using Kaplan–Meier analysis.
resultsAmong 57 eligible patients, 22 received concomitant IABP support and 35 were treated with V-A ECMO alone. After propensity score matching, 44 patients were included in the final analysis. Successful weaning from V-A ECMO was significantly more frequent in the ECMO-IABP group compared with ECMO alone (86.4% vs. 59.1%, p = 0.027). No statistically significant difference in in-hospital mortality was observed between the groups. In the unmatched cohort, 30-day survival was significantly higher in patients treated with concomitant IABP support (log-rank p = 0.038); after propensity score matching, no significant survival difference was observed (log-rank p = 0.051). Rates of major bleeding (BARC ≥ 3), vascular complications, renal failure, and neurological events were comparable between groups.
conclusionsIn patients with AMI-CS undergoing PCI supported with veno-arterial ECMO, adjunctive intra-aortic balloon pump support was associated with a higher rate of successful ECMO weaning. No significant difference in in-hospital mortality was observed after propensity score matching. A non-significant trend toward improved short-term survival was noted.
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