A 62-year-old man develops cardiogenic shock 6 hours after anterior STEMI treated by primary PCI. His BP is 70/40 mmHg with vasopressin and norepinephrine, pulmonary capillary wedge pressure 24 mmHg, cardiac index 1.5 L/min/m². The IABP-SHOCK II trial fundamentally changed management of this condition. Which conclusion did it establish?
- A Intra-aortic balloon pump (IABP) significantly reduces 30-day mortality in cardiogenic shock post-MI
- B IABP does not reduce 30-day mortality in cardiogenic shock complicating MI ✓
- C Impella CP is superior to IABP based on IABP-SHOCK II data
- D ECMO is the device of choice based on IABP-SHOCK II recommendations
Correct answer: B. IABP does not reduce 30-day mortality in cardiogenic shock complicating MI
Explanation
IABP-SHOCK II (NEJM 2012) was a landmark RCT demonstrating that IABP did not reduce 30-day all-cause mortality compared to control in patients with cardiogenic shock complicating AMI. This overturned previous ACC/AHA Class I recommendations for IABP and led to downgrade of its indication to Class III (no benefit/possibly harmful) for routine use. ESC 2017 downgraded IABP to Class IIb. Impella and ECMO were not compared in IABP-SHOCK II but are under evaluation in separate trials (DANGER-SHOCK, ECMO-CS).
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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