Risks of Prophylactic Versus Rescue Intraaortic Balloon Pump Placement for High-Risk Coronary Revascularization: A Propensity-Matched Analysis

Abstract

Objective

This propensity-matched study primarily aimed to address the impact of rescue versus prophylactic intraaortic balloon pump (IABP) placement on short-term outcomes in high-risk coronary artery disease patients undergoing coronary artery bypass graft (CABG). Secondarily, this study aimed to elucidate the effects of timing on intraoperative ischemia time, resource utilization, and postoperative complications.

Methods

A retrospective study including all high-risk CABG patients who underwent IABP placement at a single academic tertiary center between January 2000 and December 2024 was conducted. Patients who underwent prophylactic IABP placement were matched 4:1 with those who underwent rescue placement using estimated propensity scores. Time-to-event analysis was performed to assess 30-day survival. Competing risks analysis was used for 30-day readmissions with death as a competing event.

Results

A propensity-matched cohort of 239 patients with 51 participants requiring rescue IABP placement was used for the primary analysis. After double adjustment for residual covariate imbalance, the adjusted hazard of 30-day mortality with rescue IABP placement was 2.71 times higher than prophylactic placement (AHR: 2.71, 95% CI: 1.40 to 5.27, p = 0.003). Cardiopulmonary bypass and aortic cross-clamp times were prolonged by 19% (RR: 1.19, 95% CI: 1.07 to 1.33) and 12% (RR: 1.11, 95% CI: 1.01 to 1.25). ICU lengths of stay were 60% longer (RR: 1.60, 95% CI: 1.10 to 2.32).

Conclusions

These findings suggest that improved preoperative risk stratification to identify patients who will require mechanical circulatory support may reduce ischemic injury, resource utilization, and perioperative mortality.