the intra - aortic balloon pump ( iabp ) was introduced by kantrowitz et al . in 1968 as a means of circulatory support in
haemodynamically unstable patients in cardiogenic shock following acute myocardial infarction ( ami ) . in the years
today , it is used mainly as a mechanical support device in addition to pharmacological treatment in patients with low cardiac output or sustained myocardial ischaemia . in patients with ami
, iabp reduces afterload , which leads to a more effective and easier emptying of the left ventricle which will increase cardiac output .
it may also reduce myocardial ischaemia by augmenting coronary perfusion [ 2 , 3 ] .
iabp also decreases the incidence of recurrent ischaemia and infarct - related artery re - occlusion after reperfusion therapy , improves survival when used in conjunction with thrombolytic therapy compared with thrombolytic therapy alone , and enhances rescue percutaneous coronary intervention ( pci ) for failed thrombolysis .
other indications for iabp use are mechanical complications of ami , refractory ventricular arrhythmias , support during high - risk pci and preoperative support for high - risk cardiac surgery [ 48 ] . despite increasing experience , more frequent utilisation and broadening indications for iabp use , little is known about the long - term outcome after iabp treatment of ami .
this study was conducted to investigate the in - hospital and long - term outcome of patients with ami treated with iabp , and to identify predictors of in - hospital and long - term survival .
all 437 consecutive patients admitted with ami and treated with iabp between january 1990 and june 2004 were included .
indications for iabp use were ami with cardiogenic shock , haemodynamic support during pci , refractory or post - myocardial infarction angina , valvular dysfunction , mechanical complication , or refractory ventricular arrhythmia after ami . from 1990 to 1995 ,
datascope 9.5 and 10.5 french catheters were used . between 1995 and 2000 , 9-french arrow catheters were used . from 2000 until the end of 2004 , 8-french arrow catheters were used .
cardiogenic shock was defined as systolic blood pressure 90  mmhg due to impaired cardiac function diagnosed by echocardiography and associated with clinical signs of decreased cardiac output not responsive to optimalisation of filling pressures .
relevant complications were limb ischaemia requiring iabp removal , bleeding , embolic and thrombotic events , need for vascular surgery , and infection .
major bleeding was defined as bleeding requiring red cell transfusion , minor bleeding as any access site bleeding .
iabp - related infection was defined as fever with an increase in white blood cell count , c - reactive protein ( > 5 
blood and catheter tip cultures to confirm the diagnosis of iabp - related infection were not available
follow - up for vital status was obtained by contacting the civil registry and was complete in 99.5% at the reference date of december 2004 . for two patients who moved abroad , the latest available information was used .
discrete variables were compared with the  or fisher s exact test when appropriate and are presented as percentages .
continuous variables were compared with the student s t test and are presented as mean    standard deviation .
univariate and multivariate cox proportional hazard regression analyses were performed to delineate predictors of in - hospital and long - term survival .
preselected variables were age , gender , blood pressure and heart rate , diabetes , hypertension , smoking , hypercholesterolaemia , positive family history , peripheral vascular disease , prior cerebrovascular accident ( cva ) , ami , pci , coronary artery bypass grafting ( cabg ) , infarct location , extent of vessel disease , lvf , treatment during iabp use , cardiopulmonary resuscitation ( cpr ) , and iabp running time .
all 437 consecutive patients admitted with ami and treated with iabp between january 1990 and june 2004 were included .
indications for iabp use were ami with cardiogenic shock , haemodynamic support during pci , refractory or post - myocardial infarction angina , valvular dysfunction , mechanical complication , or refractory ventricular arrhythmia after ami .
from 1990 to 1995 , datascope 9.5 and 10.5 french catheters were used . between 1995 and 2000 , 9-french arrow catheters were used . from 2000 until the end of 2004 , 8-french arrow catheters were used .
cardiogenic shock was defined as systolic blood pressure 90  mmhg due to impaired cardiac function diagnosed by echocardiography and associated with clinical signs of decreased cardiac output not responsive to optimalisation of filling pressures .
relevant complications were limb ischaemia requiring iabp removal , bleeding , embolic and thrombotic events , need for vascular surgery , and infection .
major bleeding was defined as bleeding requiring red cell transfusion , minor bleeding as any access site bleeding .
iabp - related infection was defined as fever with an increase in white blood cell count , c - reactive protein ( > 5 
blood and catheter tip cultures to confirm the diagnosis of iabp - related infection were not available
follow - up for vital status was obtained by contacting the civil registry and was complete in 99.5% at the reference date of december 2004 . for two patients who moved abroad , the latest available information was used .
discrete variables were compared with the  or fisher s exact test when appropriate and are presented as percentages .
continuous variables were compared with the student s t test and are presented as mean    standard deviation .
univariate and multivariate cox proportional hazard regression analyses were performed to delineate predictors of in - hospital and long - term survival .
preselected variables were age , gender , blood pressure and heart rate , diabetes , hypertension , smoking , hypercholesterolaemia , positive family history , peripheral vascular disease , prior cerebrovascular accident ( cva ) , ami , pci , coronary artery bypass grafting ( cabg ) , infarct location , extent of vessel disease , lvf , treatment during iabp use , cardiopulmonary resuscitation ( cpr ) , and iabp running time .
the median follow - up was 2.9  years ( range , 6  months to 15  years ) .
indications for iabp use were cardiogenic shock ( 68% ) , haemodynamic support during pci ( 6% ) , high - risk cabg ( 17% ) , refractory or post - myocardial infarction angina ( 9% ) , valvular dysfunction or mechanical complications ( 8% ) , or refractory ventricular arrhythmias ( 1% ) .
forty per cent of the patients were treated with primary pci , 25% with thrombolysis , 21% had a rescue pci and 25% were treated with emergency cabg . 

table  1baseline and clinical characteristics of patients with ami treated with iabptotal ( n  =  437)age ( years)61    11male gender ( % ) 80risk factors ( % )  diabetes20  hypertension36  smoking51  hypercholesterolaemia30  peripheral vascular disease10history ( % )  cva / tia8  ami50  cabg10  pci11systolic blood pressure ( mmhg)108    28diastolic blood pressure ( mmhg)65    17heart rate ( bpm)94    25left ventricular function ( % )  normal / moderate19  impaired24  severely depressed25  unknown32three vessel / left main stem coronary disease ( % ) 44cardiogenic shock ( % ) 68infarct location ( % )  antero - septal wall64  infero - posterior wall36reperfusion therapy ( % ) 84  primary pci40  thrombolysis25  rescue pci21  cabg25  no reperfusion therapy16treatment during iccu stay ( % )  inotropic agents72  cardiopulmonary resuscitation25  mechanical ventilation54  antiarrhythmic drugs43  renal replacement therapy4iabp running time ( % )  1  day31  2 to 5  days51  6  days18data are presented as mean    sd , or as a percentageami acute myocardial infarction , iabp intra - aortic balloon pump , sd standard deviation , cva cerebrovascular accident , tia transient ischaemic attack , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , mmhg millimetres of mercury , bpm beats per minute , iccu intensive cardiac care unit baseline and clinical characteristics of patients with ami treated with iabp data are presented as mean    sd , or as a percentage ami acute myocardial infarction , iabp intra - aortic balloon pump , sd standard deviation , cva cerebrovascular accident , tia transient ischaemic attack , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , mmhg millimetres of mercury , bpm beats per minute , iccu intensive cardiac care unit baseline characteristics of patients who survived until iabp removal ( 78% , n  =  341 ) are presented in table  2 .
iabp running time in this group was 1  day in 23% , 25  days in 57% , and 6 or more days in 20% of these patients .
patients with iabp running time    6  days had a significantly lower systolic blood pressure and were more often in cardiogenic shock .
prior ami , prior cabg , diminished lvf , administration of inotropic or antiarrhythmic drugs ( aad ) and need for resuscitation were also significantly more frequent in this subgroup as compared with an iabp running time of 25  days .
table  2baseline and clinical characteristics of patients with ami who survived until iabp removal , stratified by iabp running timetotal ( n  =  341)1  day ( n  =  77)25  days ( n  =  195)6  days ( n  =  69)p valueage ( years)61    1163    1160    1160    110.1male gender ( % ) 807978840.5risk factors ( % )  diabetes212022170.7  hypertension374638260.1  smoking514650600.3  hypercholesterolaemia323631290.6  peripheral vascular disease1015970.2history ( % )  cva / tia88970.9  ami50604457<0.05  cabg1014616<0.05  pci13181290.2systolic blood pressure ( mmhg)110    28119    25110    30103    26<0.01diastolic blood pressure ( mmhg)67    1771    1666    1763    16<0.05heart rate ( bpm)92    2587    2591    2697    220.1left ventricular function ( % ) < 0.001  normal / moderate22292117  impaired28233029  severely depressed2492539  unknown26392415three vessel / left main stem coronary disease ( % ) 434542460.4cardiogenic shock ( % ) 61486371<0.05infarct location ( % ) 0.4  antero - septal wall63606654  infero - posterior wall37403446reperfusion therapy ( % )  primary pci41514325<0.01  thrombolysis261926340.1  rescue pci211321300.1  cabg303528310.5  no reperfusion therapy115922<0.01treatment during iccu stay ( % )  inotropic agents68437286<0.001  cardiopulmonary resuscitation19131730<0.05  mechanical ventilation504652520.6  antiarrhythmic drugs45264470<0.001  renal replacement therapy40570.1data are presented as mean    sd , or as a percentageami acute myocardial infarction , iabp intra - aortic balloon pump , sd standard deviation , cva cerebrovascular accident , tia transient ischaemic attack , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , mmhg millimetres of mercury , bpm beats per minute , iccu intensive cardiac care unit baseline and clinical characteristics of patients with ami who survived until iabp removal , stratified by iabp running time data are presented as mean    sd , or as a percentage ami acute myocardial infarction , iabp intra - aortic balloon pump , sd standard deviation , cva cerebrovascular accident , tia transient ischaemic attack , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , mmhg millimetres of mercury , bpm beats per minute , iccu intensive cardiac care unit cumulative survival was 58% , 47% , and 30% at 1 , 5 , and 10  years follow - up , respectively . in the patient group who survived until iabp removal
, cumulative survival was 75% , 61% , and 39% at 1 , 5 , and 10  years follow - up , respectively .
patients with iabp running time of   6  days had a significantly higher long - term mortality compared with patients with an iabp running time of 25  days ( p  <  0.05 ) ( fig .  1 ) . 

1long - term survival according to iabp running time long - term survival according to iabp running time adjusted predictors of 30-day mortality are presented in table  3 .
age ( hazard ratio ( hr ) 1.03 ; 95% ci , 1.01.06 ) , cardiogenic shock ( hr , 2.7 ; 95% ci , 1.26.0 ) , the need for inotropic agents ( hr , 7.5 ; 95% ci , 2.819.6 ) and cpr ( hr , 2.3 ; 95% ci , 1.24.2 ) were independently associated with lower 30-day survival .
independent predictors of higher 30-day survival were treatment with primary pci ( hr , 0.2 ; 95% ci , 0.10.5 ) , thrombolysis ( hr , 0.1 ; 95% ci , 0.00.8 ) , rescue pci ( hr , 0.3 ; 95% ci , 0.10.6 ) , and cabg ( hr , 0.1 ; 95% ci , 0.00.3 ) . 

table  3multivariate regression analysishr95% cipredictors of 30-day mortality in patients with ami treated with iabpage1.031.01.06cardiogenic shock2.71.26.0reperfusion therapy  primary pci0.20.10.5  thrombolysis0.10.00.8  rescue pci0.30.10.6  cabg0.10.00.3inotropic agents7.52.819.6resuscitation2.31.24.2predictors of long - term mortality in patients with ami who survived until iabp removalcva / tia1.81.03.4reperfusion therapy  primary pci0.60.41.0  rescue pci0.50.30.9  cabg0.30.10.5antiarrhythmic drugs2.31.53.3renal replacement therapy2.31.24.3only statistically significant predictors are describediabp intra - aortic balloon pump , ami acute myocardial infarction , hr hazard ratio , ci confidence interval , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , cva cerebrovascular accident , tia transient ischaemic attack multivariate regression analysis only statistically significant predictors are described iabp intra - aortic balloon pump , ami acute myocardial infarction , hr hazard ratio , ci confidence interval , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , cva cerebrovascular accident , tia transient ischaemic attack adjusted predictors of long - term mortality in patients who survived until iabp removal are presented in table  3 .
prior cva or transient ischaemic attack ( tia ; hr , 1.8 ; 95% ci , 1.03.4 ) , need for aad ( hr , 2.3 ; 95% ci , 1.53.3 ) , and renal replacement therapy ( hr , 2.3 ; 95% ci , 1.24.3 ) were independently associated with lower long - term survival .
independent predictors of higher long - term survival were primary pci ( hr , 0.6 ; 95% ci , 0.41.0 ) , rescue pci ( hr , 0.5 ; 95% ci , 0.30.9 ) , and cabg ( hr , 0.3 ; 95% ci , 0.10.5 ) . between 1990 and 1994 ( period i ) 116 patients were treated with iabp : from 1995 to 1999 ( period ii ) 141 patients and between 2000 and 2004 ( period iii ) 180 patients .
mean age was 62    9 , 59    12 , 63    11  years in period i , ii and iii respectively ( p  <  0.05 ) . no difference in the number of patients in cardiogenic shock was observed .
the use of primary pci increased from 20% in period i to 58% in period iii ( p  <  0.001 ) .
the use of thrombolytic therapy ( p  <  0.01 ) and emergency cabg ( p  <  0.01 ) decreased .
the utilisation of reperfusion therapy increased over time ( p  <  0.01 ) .
mean iabp running time decreased from three to two days between period i and iii .
<  0.001 ) thirty - day mortality decreased from 41% to 26% ( p  <  0.05 ) .
the most frequently observed complications were infection ( n  =  34 ; 8% ) , bleeding ( n  =  23 ; 5% ) , and limb ischaemia ( n  =  21 ; 5% ) .
limb ischaemia was transient in the majority of the cases ( n  =  17 , 81% ) , with either spontaneous recovery , or after iabp removal .
the median follow - up was 2.9  years ( range , 6  months to 15  years ) .
indications for iabp use were cardiogenic shock ( 68% ) , haemodynamic support during pci ( 6% ) , high - risk cabg ( 17% ) , refractory or post - myocardial infarction angina ( 9% ) , valvular dysfunction or mechanical complications ( 8% ) , or refractory ventricular arrhythmias ( 1% ) .
forty per cent of the patients were treated with primary pci , 25% with thrombolysis , 21% had a rescue pci and 25% were treated with emergency cabg . 

table  1baseline and clinical characteristics of patients with ami treated with iabptotal ( n  =  437)age ( years)61    11male gender ( % ) 80risk factors ( % )  diabetes20  hypertension36  smoking51  hypercholesterolaemia30  peripheral vascular disease10history ( % )  cva / tia8  ami50  cabg10  pci11systolic blood pressure ( mmhg)108    28diastolic blood pressure ( mmhg)65    17heart rate ( bpm)94    25left ventricular function ( % )  normal / moderate19  impaired24  severely depressed25  unknown32three vessel / left main stem coronary disease ( % ) 44cardiogenic shock ( % ) 68infarct location ( % )  antero - septal wall64  infero - posterior wall36reperfusion therapy ( % ) 84  primary pci40  thrombolysis25  rescue pci21  cabg25  no reperfusion therapy16treatment during iccu stay ( % )  inotropic agents72  cardiopulmonary resuscitation25  mechanical ventilation54  antiarrhythmic drugs43  renal replacement therapy4iabp running time ( % )  1  day31  2 to 5  days51  6  days18data are presented as mean    sd , or as a percentageami acute myocardial infarction , iabp intra - aortic balloon pump , sd standard deviation , cva cerebrovascular accident , tia transient ischaemic attack , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , mmhg millimetres of mercury , bpm beats per minute , iccu intensive cardiac care unit baseline and clinical characteristics of patients with ami treated with iabp data are presented as mean    sd , or as a percentage ami acute myocardial infarction , iabp intra - aortic balloon pump , sd standard deviation , cva cerebrovascular accident , tia transient ischaemic attack , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , mmhg millimetres of mercury , bpm beats per minute , iccu intensive cardiac care unit
baseline characteristics of patients who survived until iabp removal ( 78% , n  =  341 ) are presented in table  2 .
iabp running time in this group was 1  day in 23% , 25  days in 57% , and 6 or more days in 20% of these patients .
patients with iabp running time    6  days had a significantly lower systolic blood pressure and were more often in cardiogenic shock .
prior ami , prior cabg , diminished lvf , administration of inotropic or antiarrhythmic drugs ( aad ) and need for resuscitation were also significantly more frequent in this subgroup as compared with an iabp running time of 25  days .
table  2baseline and clinical characteristics of patients with ami who survived until iabp removal , stratified by iabp running timetotal ( n  =  341)1  day ( n  =  77)25  days ( n  =  195)6  days ( n  =  69)p valueage ( years)61    1163    1160    1160    110.1male gender ( % ) 807978840.5risk factors ( % )  diabetes212022170.7  hypertension374638260.1  smoking514650600.3  hypercholesterolaemia323631290.6  peripheral vascular disease1015970.2history ( % )  cva / tia88970.9  ami50604457<0.05  cabg1014616<0.05  pci13181290.2systolic blood pressure ( mmhg)110    28119    25110    30103    26<0.01diastolic blood pressure ( mmhg)67    1771    1666    1763    16<0.05heart rate ( bpm)92    2587    2591    2697    220.1left ventricular function ( % )
< 0.001  normal / moderate22292117  impaired28233029  severely depressed2492539  unknown26392415three vessel / left main stem coronary disease ( % ) 434542460.4cardiogenic shock ( % ) 61486371<0.05infarct location ( % ) 0.4  antero - septal wall63606654  infero - posterior wall37403446reperfusion therapy ( % )  primary pci41514325<0.01  thrombolysis261926340.1  rescue pci211321300.1  cabg303528310.5  no reperfusion therapy115922<0.01treatment during iccu stay ( % )  inotropic agents68437286<0.001  cardiopulmonary resuscitation19131730<0.05  mechanical ventilation504652520.6  antiarrhythmic drugs45264470<0.001  renal replacement therapy40570.1data are presented as mean    sd , or as a percentageami acute myocardial infarction , iabp intra - aortic balloon pump , sd standard deviation , cva cerebrovascular accident , tia transient ischaemic attack , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , mmhg millimetres of mercury , bpm beats per minute , iccu intensive cardiac care unit baseline and clinical characteristics of patients with ami who survived until iabp removal , stratified by iabp running time data are presented as mean    sd , or as a percentage ami acute myocardial infarction , iabp intra - aortic balloon pump , sd standard deviation , cva cerebrovascular accident , tia transient ischaemic attack , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , mmhg millimetres of mercury , bpm beats per minute , iccu intensive cardiac care unit
cumulative survival was 58% , 47% , and 30% at 1 , 5 , and 10  years follow - up , respectively . in the patient group who survived until iabp removal
, cumulative survival was 75% , 61% , and 39% at 1 , 5 , and 10  years follow - up , respectively .
patients with iabp running time of   6  days had a significantly higher long - term mortality compared with patients with an iabp running time of 25  days ( p  <  0.05 ) ( fig .  1 ) . 

1long - term survival according to iabp running time long - term survival according to iabp running time adjusted predictors of 30-day mortality are presented in table  3 .
age ( hazard ratio ( hr ) 1.03 ; 95% ci , 1.01.06 ) , cardiogenic shock ( hr , 2.7 ; 95% ci , 1.26.0 ) , the need for inotropic agents ( hr , 7.5 ; 95% ci , 2.819.6 ) and cpr ( hr , 2.3 ; 95% ci , 1.24.2 ) were independently associated with lower 30-day survival .
independent predictors of higher 30-day survival were treatment with primary pci ( hr , 0.2 ; 95% ci , 0.10.5 ) , thrombolysis ( hr , 0.1 ; 95% ci , 0.00.8 ) , rescue pci ( hr , 0.3 ; 95% ci , 0.10.6 ) , and cabg ( hr , 0.1 ; 95% ci , 0.00.3 ) . 

table  3multivariate regression analysishr95% cipredictors of 30-day mortality in patients with ami treated with iabpage1.031.01.06cardiogenic shock2.71.26.0reperfusion therapy  primary pci0.20.10.5  thrombolysis0.10.00.8  rescue pci0.30.10.6  cabg0.10.00.3inotropic agents7.52.819.6resuscitation2.31.24.2predictors of long - term mortality in patients with ami who survived until iabp removalcva / tia1.81.03.4reperfusion therapy  primary pci0.60.41.0  rescue pci0.50.30.9  cabg0.30.10.5antiarrhythmic drugs2.31.53.3renal replacement therapy2.31.24.3only statistically significant predictors are describediabp intra - aortic balloon pump , ami acute myocardial infarction , hr hazard ratio , ci confidence interval , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , cva cerebrovascular accident , tia transient ischaemic attack multivariate regression analysis only statistically significant predictors are described iabp intra - aortic balloon pump , ami acute myocardial infarction , hr hazard ratio , ci confidence interval , cabg coronary artery bypass grafting , pci percutaneous coronary intervention , cva cerebrovascular accident , tia transient ischaemic attack adjusted predictors of long - term mortality in patients who survived until iabp removal are presented in table  3 .
prior cva or transient ischaemic attack ( tia ; hr , 1.8 ; 95% ci , 1.03.4 ) , need for aad ( hr , 2.3 ; 95% ci , 1.53.3 ) , and renal replacement therapy ( hr , 2.3 ; 95% ci , 1.24.3 ) were independently associated with lower long - term survival .
independent predictors of higher long - term survival were primary pci ( hr , 0.6 ; 95% ci , 0.41.0 ) , rescue pci ( hr , 0.5 ; 95% ci , 0.30.9 ) , and cabg ( hr , 0.3 ; 95% ci , 0.10.5 ) .
between 1990 and 1994 ( period i ) 116 patients were treated with iabp : from 1995 to 1999 ( period ii ) 141 patients and between 2000 and 2004 ( period iii ) 180 patients .
mean age was 62    9 , 59    12 , 63    11  years in period i , ii and iii respectively ( p  <  0.05 ) . no difference in the number of patients in cardiogenic shock was observed .
the use of primary pci increased from 20% in period i to 58% in period iii ( p  <  0.001 ) .
the use of thrombolytic therapy ( p  <  0.01 ) and emergency cabg ( p  <  0.01 ) decreased .
the utilisation of reperfusion therapy increased over time ( p  <  0.01 ) .
mean iabp running time decreased from three to two days between period i and iii .
<  0.001 ) thirty - day mortality decreased from 41% to 26% ( p  <  0.05 ) .
complications were observed in 88 patients ( 20% ) . the most frequently observed complications were infection ( n  =  34 ; 8% ) , bleeding ( n  =  23 ; 5% ) , and limb ischaemia ( n  =  21 ; 5% ) . of all bleeds , five patients had major bleeding .
limb ischaemia was transient in the majority of the cases ( n  =  17 , 81% ) , with either spontaneous recovery , or after iabp removal .
the main finding of this study is that the use of the iabp in patients admitted with ami is associated with an excellent prognosis in hospital survivors .
almost half of these patients are alive after 10-year follow - up . in - hospital
mortality declined over the years and was lower in patients in whom iabp support was required for a relatively short period ( 5  days or less ) . in this study in - hospital survival
this observation , however , must be seen in perspective to the percentage of patients in cardiogenic shock in our population ( 68% compared with 1927% in other studies ) [ 912 ] .
. the relatively high survival rate despite a high percentage of cardiogenic shock may be due to the higher use of reperfusion therapy ( 84% ) in our study compared with other studies .
the incidence of cardiogenic shock has only slightly declined over the years but in - hospital survival increased due to increased use of reperfusion therapy [ 1416 ] .
a recent report by our group on a subgroup of patients from this present study also underlines the usefulness of iabp support in conjunction with reperfusion therapy leading to encouraging 30-day and long - term survival rates in patients with ami complicated by cardiogenic shock .
predictors of lower in - hospital survival were advanced age , diminished lvf , longer iabp running time , the need for inotropic support and resuscitation .
this is in line with the findings of stone et al . , who also found that increased age and cardiogenic shock were associated with worse in - hospital survival and that coronary revascularisation was a strong independent predictor of in - hospital survival .
to our knowledge , this is the first study reporting up to 15  years of follow - up of patients admitted with ami and treated with iabp .
our results show that although initial in - hospital mortality is relatively high , when discharged from the hospital alive , long - term survival was better than expected .
almost 50% of these patients are still alive after 10  years follow - up . as a large proportion of our population was in cardiogenic shock at presentation
predictors of long - term mortality were previous cva / tia , the need for aad and renal replacement therapy .
however , pci or cabg were associated with sustained long - term survival benefit in a study by van domburg et al . .
this shows that the beneficial effect of reperfusion therapy extends beyond the acute moment . despite older age , a decline in in - hospital mortality
was observed over the years which seems to be related to expanding treatment options and the increasing use of reperfusion therapy . in the latest inclusion period almost 60% underwent primary pci .
early iabp removal was possible in patients who had the iabp inserted during pci for transient hypotension or because of a large myocardial area at risk . from days  2 to 5
iabp running time of 6  days was associated with increased in - hospital mortality .
these patients survive the first days after admission but either remain unstable or develop complications eventually leading to death .
the most frequent complications were limb ischaemia , bleeding from the iabp entry site and infection .
the benchmark registry reported a complication rate of 8.1% which is lower than observed in this study .
detection of diminished pulsations may be subjective and may potentially lead to a higher ischaemia percentage .
this may also be caused by our less strict definition of iabp - related infection as no definite tip or blood cultures were available to confirm the diagnosis .
however , a study by cristal et al . reported true bacteraemia and sepsis in iabp patients in 15% and 12% , respectively , mainly during the first 48  h after insertion .
as shown in previous studies , complication rate decreased with the introduction of smaller french size catheters [ 22 , 25 , 26 ] . since
erasmus mc is a tertiary referral centre , selection bias may influence our results . however , this probably leads to an underestimation of the effect as our study population consists of high - risk patients .
due to incomplete documentation of several clinical variables , information bias can not be excluded .
since erasmus mc is a tertiary referral centre , selection bias may influence our results .
however , this probably leads to an underestimation of the effect as our study population consists of high - risk patients .
due to incomplete documentation of several clinical variables , information bias can not be excluded .
this is , to our knowledge , the first study reporting on 15  years of follow - up in patients with ami treated with iabp .
almost half of the in - hospital survivors are still alive after 10  years of follow - up , which is better than expected .
furthermore , in - hospital mortality was related to iabp running time , with the highest mortality during the first day ( patients in severe cardiogenic shock who could not be stabilised ) , a decrease in mortality from days  2 to 5 and from day  6 on again a higher mortality ( patients with severe impairment who did not recover ) .
finally , a trend towards lower in - hospital mortality was observed over the years .
so , despite older age and a trend towards more cardiogenic shock , survival is quite good , and aggressive haemodynamic support is useful even up to 5  days after iabp insertion .
 objectiveto evaluate a 30-day and long - term outcome of patients with acute myocardial infarction ( ami ) treated with intra - aortic balloon pump ( iabp ) counterpulsation and to identify predictors of a 30-day and long - term all - cause mortality.methodsretrospective cohort study of 437 consecutive ami patients treated with iabp between january 1990 and june 2004 . 
 a cox proportional hazards model was used to identify predictors of a 30-day and long - term all - cause mortality.resultsmean age of the study population was 61    11  years , 80% of the patients were male , and 68% had cardiogenic shock . 
 survival until iabp removal after successful haemodynamic stabilisation was 78% ( n  =  341 ) . 
 cumulative 30-day survival was 68% . 
 median follow - up was 2.9  years ( range , 6  months to 15  years ) . in patients who survived until iabp removal , cumulative 1- , 5- , and 
 10-year survival was 75% , 61% , and 39% , respectively . 
 independent predictors of higher long - term mortality were prior cerebrovascular accident ( hazard ratio ( hr ) , 1.8 ; 95% confidence interval ( ci ) , 1.03.4 ) , need for antiarrhythmic drugs ( hr , 2.3 ; 95% ci , 1.53.3 ) , and need for renal replacement therapy ( hr , 2.3 ; 95% ci , 1.24.3 ) . 
 independent predictors of lower long - term mortality were primary percutaneous coronary intervention ( pci ; hr , 0.6 ; 95% ci , 0.41.0 ) , failed thrombolysis with rescue pci ( hr , 0.5 ; 95% ci , 0.30.9 ) , and coronary artery bypass grafting ( hr , 0.3 ; 95% ci , 0.10.5).conclusionsdespite high in - hospital mortality in patients with ami treated with iabp , a favourable number of patients survived in the long - term . 
 these results underscore the value of aggressive haemodynamic support of patients throughout the acute phase of ami . 
Introduction
Methods
Patient Selection
Balloon Pump
Study Definitions
Follow-up
Statistical Analysis
Results
Baseline Characteristics
Predictors of Successful IABP Weaning
Thirty-Day and Long-term Outcome
IABP Use Over the Years
IABP-Related Complications
Discussion
Limitations
Conclusions