LandmarkRCT

IABP-SHOCK II

Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock

New England Journal of Medicine, 2012 · Multicenter, randomized, open-label trial.

Clinical question

Does routine intra-aortic balloon pump (IABP) support improve survival in MI-related cardiogenic shock undergoing early revascularization?

Population: 600 patients with cardiogenic shock complicating acute MI, undergoing early revascularization.
Intervention: IABP placement.
Comparator: No IABP (standard medical therapy).
Primary outcome: 30-day all-cause mortality.
Result: No significant difference in 30-day mortality; long-term follow-up to 6 years confirmed no mortality benefit.

What the trial found

Routine IABP use did not reduce 30-day mortality in patients with MI-related cardiogenic shock undergoing early revascularization, despite prior registry data and a class I guideline recommendation supporting its use.

Current guideline position

Current guidelines no longer give a strong/routine recommendation for IABP in MI-related cardiogenic shock, reflecting this trial.

Clinical interpretation

This trial reversed a previously guideline-endorsed practice that had been based mainly on registry and observational data — a clear example of randomized evidence overturning weaker prior evidence. IABP is no longer used routinely for MI-related cardiogenic shock.

Limitations

Open-label design.
Restricted to MI-related cardiogenic shock with early revascularization; does not address IABP use in other cardiogenic shock etiologies.

High certainty

Clinical Context & Relevant Topics (1)

Disease Reference

Cardiogenic Shock

Primary pump failure, SCAI staging (A–E), PAC hemodynamics (CPO, PAPi), inotrope selection, emergent revascularization, and mechanical circulatory support.

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