***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background : Sustained hypotension , cardiogenic shock , and heart failure all imply a poor prognosis in acute myocardial infa rct ion ( MI ) . We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation ( IABP ) to st and ard treatment for MI , in an international trial among hospitals without primary angioplasty capabilities . Methods : We r and omized 57 patients with MI complicated by sustained hypotension , possible cardiogenic shock , or possible heart failure to receive either fibrinolytic therapy and IABP or fibrinolysis alone . The primary end point was all-cause mortality at 6 months . Results : In all , IABP was inserted in 27 of 30 assigned patients a median 30 minutes after fibrinolysis began and continued for a median 34 hours . Of the 27 patients assigned to fibrinolysis alone , 9 deteriorated such that IABP was required . The IABP group was at slightly higher risk at baseline , but the incidence of the primary end point did not differ significantly between groups ( 34 % for combined treatment versus 43 % for fibrinolysis alone ; adjusted P = 0.23 ) . Patients with Killip class III or IV showed a trend toward greater benefit from IABP ( 6-month mortality 39 % for combined therapy versus 80 % for fibrinolysis alone ; P = 0.05 ) . Conclusions : While early IABP use was not associated with a definitive survival benefit when added to fibrinolysis for patients with MI and hemodynamic compromise in this small trial , its use suggested a possible benefit for patients with the most severe heart failure or hypotension . Abbreviated Abstract . We assessed the benefit of adding 48 hours of intra-aortic balloon counterpulsation to fibrinolytic therapy among 57 patients with acute myocardial infa rct ion complicated by sustained hypotension , possible cardiogenic shock , or possible heart failure . The primary end point , mortality at 6 months , did not differ between groups ( 34 % for combined treatment versus 43 % for fibrinolysis alone [ n = 27 ] ; adjusted P = 0.23 ) , although patients with Killip class III or IV did show a trend toward greater benefit from IABP ( 39 % for combined therapy versus 80 % for fibrinolysis ; P = 0.05 ) Objective : Patients undergoing percutaneous coronary intervention ( PCI ) for acute myocardial infa rct ion with cardiogenic shock ( CS ) are often treated with intra-aortic balloon pump counterpulsation ( IABP ) , even though the evidence to support this is limited . We determined whether IABP as an addition to PCI-centered therapy ameliorates multiorgan dysfunction syndrome ( MODS ) in patients with acute myocardial infa rct ion complicated by CS . Design : A prospect i ve , r and omized , controlled , open-label clinical trial recruiting patients between March 2003 and June 2004 ( Clinical Trials.gov ID NCT00469248 ) . Setting : Tertiary care university hospital . Patients and Interventions : Forty-five consecutive patients with AMI and CS undergoing PCI were r and omized to treatment with or without IABP . Measurements and Main Results : Acute Physiology and Chronic Health Evaluation ( APACHE ) II scores ( primary outcome measure ) , hemodynamic values , inflammatory markers , and plasma brain natriuretic peptide ( BNP ) levels ( secondary outcomes ) were collected over 4 days from r and omization . The prospect i ve hypothesis was that adding IABP therapy to “ st and ard care ” would improve CS-triggered MODS . The addition of IABP to st and ard therapy did not result in a significant improvement in MODS ( measured by serial APACHE II scoring over 4 days ) . IABP use had no significant effect on cardiac index or systemic inflammatory activation , although BNP levels were significantly lower in IABP-treated patients . Initial and serial APACHE II scoring correlated with mortality better than cardiac index , systemic inflammatory state , and BNP levels in this group of patients . Nonsurvivors had significantly higher initial APACHE II scores ( 29.9 ± 2.88 ) than survivors ( 18.1 ± 1.66 , p < .05 ) . Nevertheless , discrepancies among patients within the groups can not be ruled out and might interfere with our results . Conclusions : In this r and omized trial addressing addition of IABP in CS patients , mechanical support was associated only with modest effects on reduction of APACHE II score as a marker of severity of disease , improvement of cardiac index , reduction of inflammatory state , or reduction of BNP biomarker status compared with medical therapy alone . However , the limitations of our present trial preclude any definitive conclusion , but request for a larger prospect i ve , r and omized , multicentered trial with mortality as primary end point BACKGROUND AND AIM Despite major advances in the treatment of heart failure , cardiogenic shock ( CGS ) remains associated with substantial mortality . Recent data suggest that the T and emHeart percutaneous ventricular assist device ( pVAD ) may be useful in the management of CGS . The aim of this prospect i ve r and omized study was to test the hypothesis that the T and emHeart ( pVAD ) provides superior hemodynamic support compared with intraaortic balloon pumping ( IABP ) . METHODS Forty-two patients from 12 centers presenting within 24 hours of developing CGS were included in the study and treated in an initial roll-in phase ( n = 9 ) or r and omized to treatment with IABP ( n = 14 ) or T and emHeart pVAD ( n = 19 ) . Thirty patients ( 71 % ) had persistent CGS despite having an IABP in place at the time of study enrollment . RESULTS Cardiogenic shock was due to myocardial infa rct ion in 70 % of the patients and decompensated heart failure in most of the remaining patients . The mean duration of support was 2.5 days . Compared with IABP , the T and emHeart pVAD achieved significantly greater increases in cardiac index and mean arterial blood pressure and significantly greater decreases in pulmonary capillary wedge pressure . Overall 30-day survival and severe adverse events were not significantly different between the 2 groups . CONCLUSION In patients presenting within 24 hours of the development of CGS , T and emHeart significantly improves hemodynamic parameters , even in patients failing IABP . Larger-scale studies are required to assess the influence of improved hemodynamics on survival BACKGROUND In current international guidelines the recommendation for intra-aortic balloon pump ( IABP ) use has been down grade d in cardiogenic shock complicating acute myocardial infa rct ion on the basis of registry data . In the largest r and omised trial ( IABP-SHOCK II ) , IABP support did not reduce 30 day mortality compared with control . However , previous trials in cardiogenic shock showed a mortality benefit only at extended follow-up . The present analysis therefore reports 6 and 12 month results . METHODS The IABP-SHOCK II trial was a r and omised , open-label , multicentre trial . Patients with cardiogenic shock complicating acute myocardial infa rct ion who were undergoing early revascularisation and optimum medical therapy were r and omly assigned ( 1:1 ) to IABP versus control via a central web-based system . The primary efficacy endpoint was 30 day all-cause mortality , but 6 and 12 month follow-up was done in addition to quality -of-life assessment for all survivors with the Euroqol-5D question naire . A masked central committee adjudicated clinical outcomes . Patients and investigators were not masked to treatment allocation . Analysis was by intention to treat . This trial is registered at Clinical Trials.gov , NCT00491036 . FINDINGS Between June 16 , 2009 , and March 3 , 2012 , 600 patients were assigned to IABP ( n=301 ) or control ( n=299 ) . Of 595 patients completing 12 month follow-up , 155 ( 52 % ) of 299 patients in the IABP group and 152 ( 51 % ) of 296 patients in the control group had died ( relative risk [ RR ] 1·01 , 95 % CI 0·86 - 1·18 , p=0·91 ) . There were no significant differences in reinfa rct ion ( RR 2·60 , 95 % CI 0·95 - 7·10 , p=0·05 ) , recurrent revascularisation ( 0·91 , 0·58 - 1·41 , p=0·77 ) , or stroke ( 1·50 , 0·25 - 8·84 , p=1·00 ) . For survivors , quality -of-life measures including mobility , self-care , usual activities , pain or discomfort , and anxiety or depression did not differ significantly between study groups . INTERPRETATION In patients undergoing early revascularisation for myocardial infa rct ion complicated by cardiogenic shock , IABP did not reduce 12 month all-cause mortality . FUNDING German Research Foundation ; German Heart Research Foundation ; German Cardiac Society ; Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte ; University of Leipzig -- Heart Centre ; Maquet Cardiopulmonary ; Teleflex Medical OBJECTIVES Our goal was to describe the functional status of cardiogenic shock survivors , identify the correlates of cardiogenic shock , and compare global quality of life and functional status of patients r and omly assigned to treatment with emergency revascularization ( ERV ) versus initial medical stabilization ( IMS ) . BACKGROUND Historically , the hospital survival rate of patients with cardiogenic shock complicating acute myocardial infa rct ion ( MI ) has been very low . Shock survivors are salvaged from a critically ill state , and their later functional status is not well documented . The SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK ( SHOCK ) trial showed significantly improved one-year survival after ERV compared with IMS . METHODS The SHOCK trial survivors completed interviews at 2 weeks after discharge and at 6 and 12 months after MI . Functional status assessment included the Multidimensional Index of Life Quality and New York Heart Association ( NYHA ) congestive heart failure functional class . RESULTS Eighty-seven percent of one-year survivors of the SHOCK trial were in NYHA functional class I or II . Between two weeks after discharge and one year after MI , improvement was similar in the two treatment groups ( 18 % overall ) , but fewer patients remained stable ( 44 % vs. 71 % ) , and more patients worsened or died ( 34 % vs. 15 % ) in the IMS group compared with those assigned to ERV . Assignment to ERV was the only independent predictor of outcome at one year . CONCLUSIONS Although one-year mortality after ERV is still high ( 54 % ) , most survivors have good functional status . The ERV patients have a lower rate of deterioration than IMS patients . The level of recovery for shock patients undergoing ERV is similar to that of historical controls not in cardiogenic shock undergoing elective revascularization Background Aortic counterpulsation has been observed to reduce the rate of reocclusion of the infa rct -related artery after patency has been restored during acute myocardial infa rct ion in observational studies . To evaluate the benefit-to-risk ratio of aortic counterpulsation during the early phase of myocardial infa rct ion , a multicenter r and omized clinical trial was performed . Methods and Results Patients who had patency restored during acute cardiac catheterization within the first 24 hours of onset of myocardial infa rct ion were r and omly assigned to aortic counterpulsation for 48 hours versus st and ard care . Intravenous heparin was used similarly in both groups and was continued for a median ( 25th , 75th percentile ) of 5 ( 2,7 ) days . A total of 182 patients were enrolled ; 96 were assigned to aortic counterpulsation  and 86 to st and ard care .  Repeat cardiac catheterization  was performed at a median of 5 ( 4,6 ) days after r and omization in 89 % of patients assigned to aortic counterpulsation and in 90 % of control patients . Patients r and omized to aortic counterpulsation had similar rates of severe bleeding complications ( 2 % versus 1 % ) , number of units of blood transfused ( mean , 1.3±2.6 versus 0.9±1.8 units ) , and vascular repair or thrombectomy ( 5 % versus 2 % ) compared with patients treated in a conventional manner . Patients r and omized to aortic counterpulsation had significantly less reocclusion of the infa rct -related artery during follow-up compared with control patients ( 8 % versus 21 % , P<.03 ) . In addition , there was a significantly lower event rate in patients assigned to aortic counterpulsation in terms of a composite clinical end point ( death , stroke , reinfa rct ion , need for emergency revascularization with angioplasty or bypass surgery , or recurrent ischemia ) : 13 % versus 24 % , P<.04 . Conclusions This r and omized trial showed that careful use of prophylactic aortic counterpulsation can prevent reocclusion of the infa rct -related artery and improve overall clinical outcome in patients undergoing acute cardiac catheterization during myocardial infa rct ion Background : The benefit of 
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The high incidence of complications such as moderate and severe bleeding or infection in the control groups has to be attributed to interventions with other LVAD .
Available evidence suggests that IABP may have a beneficial effect on some haemodynamic parameters .
However , this did not result in survival benefits so there is no convincing r and omised data to support the use of IABP in infa rct -related cardiogenic shock