{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:43:25Z","timestamp":1760035405801,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Intra-aortic balloon pump (IABP) augments coronary perfusion during high-risk percutaneous coronary interventions (PCI). We sought to identify patients who benefited from prophylactic IABP (P-IABP) compared to rescue-IABP (R-IABP). Methods: All consecutive non-cardiogenic shock patients undergoing high-risk PCI with IABP support at Ulm University Hospital, Germany, between 2012 and 2020 were grouped based on the timing of IABP insertion in the pre-interventional P-IABP or peri-interventional R-IABP group. We compared the primary endpoint peri-interventional high-sensitivity Troponin T (hsTnT) increase, sought baseline characteristics associated with the endpoint in the R-IABP group, and compared their correlation strengths between the groups. Results: Interventional outcomes of 44 patients with P-IABP implantation were compared with those of 15 patients with R-IABP implantation. P-IABP was associated with a lower peri-interventional hsTnT increase (p = 0.008, r = 0.390). In the R-IABP group, the presence of ST-segment elevation (p = 0.037, r = 0.631), low systolic blood pressure (RRsyst) (p = 0.007, r = 0.893 (inverse correlation)), and elevated NT-proBNP levels (p &lt; 0.001, r = 0.953) were associated with higher hsTnT increases. HsTnT increase was significantly smaller in the P-IABP group in patients with low RRsyst (IZI = 2.6) and high NT-proBNP levels (IZI = 3.36). Patients with RRsyst &lt; 120 mmHg (p = 0.007) and NT-proBNP levels \u2265 900 pg\/mL (Cohen\u2019s d = 0.70, respectively 1.17 for \u22655000 pg\/mL and 5.01 for \u226510,000 pg\/mL) showed lower peri-interventional hsTnT increase when treated with P-IABP compared to R-IABP, while patients with NT-proBNP levels &lt; 900 pg\/mL showed a contrary effect (Cohen\u2019s d = \u22120.90). Cox regression analysis showed that a high peri-interventional hsTnT increase was significantly associated with a shorter survival time (p = 0.046). Conclusions: P-IABP use in high-risk PCI was associated with reduced peri-interventional myocardial injury, as measured by lower hsTnT increase, which was associated with improved survival in patients with low systolic blood pressure and elevated NT-proBNP levels. Thus, these conditions should be considered for indicating P-IABP.<\/jats:p>","DOI":"10.3390\/jcm14134796","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T08:58:23Z","timestamp":1751878703000},"page":"4796","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prophylactic Intra-Aortic Balloon Pump Implantation Reduces Peri-Interventional Myocardial Injury During High-Risk Percutaneous Coronary Intervention in Patients Presenting with Low Normal Blood Pressure and with Heart Failure"],"prefix":"10.3390","volume":"14","author":[{"given":"Sascha","family":"d\u2019Almeida","sequence":"first","affiliation":[{"name":"Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, Ulm University Hospital, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-9152-2452","authenticated-orcid":false,"given":"Stefanie","family":"Andre\u00df","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, Ulm University Hospital, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sebastian","family":"Weinig","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, Ulm University Hospital, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1042-9006","authenticated-orcid":false,"given":"Benjamin","family":"Mayer","sequence":"additional","affiliation":[{"name":"Institute for Epidemiology and Medical Biometry, Ulm University, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wolfgang","family":"Rottbauer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, Ulm University Hospital, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sinisa","family":"Markovic","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, Ulm University Hospital, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"Buckert","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Angiology, Pneumology, and Intensive Care Medicine, Ulm University Hospital, 89075 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1093\/bjaceaccp\/mkn051","article-title":"Principles of intra-aortic balloon pump counterpulsation","volume":"9","author":"Krishna","year":"2009","journal-title":"Contin. Educ. Anaesth. Crit. Care Pain"},{"key":"ref_2","unstructured":"Khan, T.M., and Siddiqui, A.H. (2024). Intra-Aortic Balloon Pump. StatPearls, StatPearls Publishing."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1001\/jamainternmed.2022.2735","article-title":"Clinical Outcomes and Cost Associated with an Intravascular Microaxial Left Ventricular Assist Device vs. Intra-aortic Balloon Pump in Patients Presenting with Acute Myocardial Infarction Complicated by Cardiogenic Shock","volume":"182","author":"Miller","year":"2022","journal-title":"JAMA Intern. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1001\/jama.2020.0254","article-title":"Association of Use of an Intravascular Microaxial Left Ventricular Assist Device vs. Intra-aortic Balloon Pump with In-Hospital Mortality and Major Bleeding Among Patients with Acute Myocardial Infarction Complicated by Cardiogenic Shock","volume":"323","author":"Dhruva","year":"2020","journal-title":"JAMA"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1002\/ccd.30913","article-title":"Mechanical circulatory support versus vasopressors alone in patients with acute myocardial infarction and cardiogenic shock undergoing percutaneous coronary intervention","volume":"103","author":"Javaid","year":"2024","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.1161\/CIRCULATIONAHA.112.098194","article-title":"A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: The PROTECT II study","volume":"126","author":"Kleiman","year":"2012","journal-title":"Circulation"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e000987","DOI":"10.1136\/openhrt-2018-000987","article-title":"Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock","volume":"6","author":"Alushi","year":"2019","journal-title":"Open Heart"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/s13019-016-0513-0","article-title":"IABP: History-evolution-pathophysiology-indications: What we need to know","volume":"11","author":"Parissis","year":"2016","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1161\/01.RES.26.6.753","article-title":"Effects of intra-aortic balloon counterpulsation on cardiac performance, oxygen consumption, and coronary blood flow in dogs","volume":"26","author":"Powell","year":"1970","journal-title":"Circ. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1016\/j.mayocp.2022.12.007","article-title":"Cardiogenic Shock Classification and Associated Mortality Risk","volume":"98","author":"Hill","year":"2023","journal-title":"Mayo Clin. Proc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1016\/j.amjcard.2016.11.037","article-title":"Effect of Early Initiation of Mechanical Circulatory Support on Survival in Cardiogenic Shock","volume":"119","author":"Basir","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1002\/ccd.30137","article-title":"Timing of mechanical circulatory support during primary angioplasty in acute myocardial infarction and cardiogenic shock: Systematic review and meta-analysis","volume":"99","author":"Archilletti","year":"2022","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1001\/jama.2010.1190","article-title":"BCIS-1 InvestigatorsBCIS-1 Investigators. Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: A randomized controlled trial","volume":"304","author":"Perera","year":"2010","journal-title":"JAMA"},{"key":"ref_14","first-page":"44","article-title":"Hemodynamic Support for High-Risk PCI","volume":"13","author":"Kearney","year":"2019","journal-title":"Card. Interv. Today"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e7","DOI":"10.1016\/j.jacc.2015.03.036","article-title":"2015 SCAI\/ACC\/HFSA\/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care: Endorsed by the American Heart Association, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; affirmation of value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d\u2019intervention","volume":"65","author":"Rihal","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1056\/NEJMoa1208410","article-title":"Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock","volume":"367","author":"Thiele","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2129","DOI":"10.1093\/eurheartj\/ehw128","article-title":"ESCScientific Document Group 2016 ESCGuidelines for the diagnosis treatment of acute chronic heart failure: The Task Force for the diagnosis treatment of acute chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the, ESC","volume":"37","author":"Ponikowski","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1093\/eurheartj\/ehi631","article-title":"NT-proBNP testing for diagnosis and short-term prognosis in acute destabilized heart failure: An international pooled analysis of 1256 patients: The International Collaborative of NT-proBNP Study","volume":"27","author":"Januzzi","year":"2006","journal-title":"Eur. Heart J."},{"key":"ref_19","unstructured":"Trang, T.T.H. (2024, November 15). Value of NT-proBNP Test in Diagnosis, Monitoring, Prognosis and Screening of Heart Failure. Value of NT-proBNP Test in Diagnosis, Monitoring, Prognosis and Screening of Heart Failure. Available online: https:\/\/www.vinmec.com."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1556\/650.2017.30761","article-title":"Extr\u00e9m magas B t\u00edpus\u00fa natriureticus prohormon prognosztikai szerepe a sz\u00edvel\u00e9gtelens\u00e9g miatt kezelt betegek k\u00f3rh\u00e1zi hal\u00e1loz\u00e1s\u00e1ra [The prognostic role of extremely high levels of the B-type natriuretic prohormone with regard to the in-hospital mortality of patients hospitalized for heart failure]","volume":"158","author":"Nagy","year":"2017","journal-title":"Orv. Hetil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1161\/HYP.0000000000000066","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines","volume":"71","author":"Whelton","year":"2018","journal-title":"Hypertension"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/j.jacc.2007.09.041","article-title":"Cardiac Magnetic Resonance Imaging Study for Quantification of Infarct Size Comparing Directly Serial Versus Single Time-Point Measurements of Cardiac Troponin T","volume":"5","author":"Giannitsis","year":"2008","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1016\/S0022-5223(19)39623-0","article-title":"Clinical and hemodynamic criteria for use of the intra-aortic balloon pump in patients requiring cardiac surgery","volume":"72","author":"Bolooki","year":"1976","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1016\/j.amjcard.2006.03.036","article-title":"Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention","volume":"98","author":"Mishra","year":"2006","journal-title":"Am. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/S0002-9149(99)00185-X","article-title":"Intra-aortic balloon counterpulsation before primary percutaneous transluminal coronary angioplasty reduces catheterization laboratory events in high-risk patients with acute myocardial infarction","volume":"84","author":"Brodie","year":"1999","journal-title":"Am. J. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/1749-8090-6-147","article-title":"Intra aortic balloon pump: Literature review of risk factors related to complications of the intraaortic balloon pump","volume":"6","author":"Parissis","year":"2011","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1367","DOI":"10.1016\/S0735-1097(84)80273-9","article-title":"Effects of intraaortic balloon counterpulsation on myocardial blood flow in patients with severe coronary artery disease","volume":"3","author":"Port","year":"1984","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1161\/01.CIR.68.1.117","article-title":"Augmentation of regional coronary blood flow by intra-aortic balloon counterpulsation in patients with unstable angina","volume":"68","author":"Fuchs","year":"1983","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1001\/jama.2011.1280","article-title":"Intra-aortic Balloon Counterpulsation and Infarct Size in Patients with Acute Anterior Myocardial Infarction Without Shock: The CRISP AMI Randomized Trial","volume":"306","author":"Patel","year":"2011","journal-title":"JAMA"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1161\/CIRCOUTCOMES.110.960385","article-title":"Use and effectiveness of intra-aortic balloon pumps among patients undergoing high risk percutaneous coronary intervention: Insights from the National Cardiovascular Data Registry","volume":"5","author":"Curtis","year":"2012","journal-title":"Circ Cardiovasc. Qual Outcomes"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1494","DOI":"10.1136\/heartjnl-2015-308562","article-title":"Percutaneous mechanical circulatory support: Current concepts and future directions","volume":"102","author":"Briceno","year":"2016","journal-title":"Heart"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1161\/CIRCULATIONAHA.116.022061","article-title":"Treatment of higher-risk patients with an indication for revascularization: Evolution within the field of contemporary percutaneous coronary intervention","volume":"134","author":"Kirtane","year":"2016","journal-title":"Circulation"},{"key":"ref_33","unstructured":"McCabe, J.M. (2018). Hemodynamic Support for CTO PCI: Who, When, & How, Transcatheter Cardiovascular Therapeutics (TCT)."},{"key":"ref_34","first-page":"e232","article-title":"Contemporary management of cardiogenic shock: A scientific statement from the American Heart Association","volume":"136","author":"Katz","year":"2017","journal-title":"Circulation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1177\/039139880202501207","article-title":"Heart rate effect on hemodynamics during mechanical assistance by the intra-aortic balloon pump","volume":"25","author":"Papaioannou","year":"2002","journal-title":"Int. J. Artif. Organs"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1016\/j.amjcard.2018.06.042","article-title":"Heart Rate as a Predictor of Outcome Following Percutaneous Coronary Intervention","volume":"122","author":"Reid","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2442","DOI":"10.1016\/j.bbadis.2012.12.014","article-title":"Biomarkers and diagnostics in heart failure","volume":"1832","author":"Gaggin","year":"2013","journal-title":"Biochim. Biophys. Acta (BBA)\u2014Mol. Basis Dis."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4796\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:05:57Z","timestamp":1760033157000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4796"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,7]]},"references-count":37,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134796"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134796","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,7,7]]}}}