A 68-year-old man develops cardiogenic shock 4 hours after anterior STEMI. Despite primary PCI to the LAD, he remains hypotensive (BP 82/50 mmHg) with cold extremities and pulmonary edema. The IABP-SHOCK II trial showed that intra-aortic balloon pump (IABP) in this setting:

• A Significantly reduced 30-day mortality compared to medical therapy alone
• B Did not reduce 30-day or 12-month mortality compared to controls ✓
• C Reduced mortality only in patients without prior revascularization
• D Improved outcomes when inserted before primary PCI (prophylactic use)

Explanation

The IABP-SHOCK II trial (Thiele et al., 2012, NEJM) was a landmark randomized trial that demonstrated IABP did NOT reduce 30-day or 12-month all-cause mortality in MI-associated cardiogenic shock, irrespective of revascularization strategy. This led to downgrading of routine IABP use in cardiogenic shock from Class I to Class IIb/III recommendation in ESC guidelines. Percutaneous mechanical circulatory support devices (Impella, VA-ECMO) are now preferred but also lack strong mortality benefit in unselected patients. IABP still has a role in select cases (mechanical complications of MI like acute MR or VSD).

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.