This prospective Swedish registry study included 2991 patients with myocardial infarction complicated by cardiogenic shock undergoing PCI; 737 received IABP. Investigators used hospital treatment preference as an instrumental variable to account for baseline differences. Overall 30-day mortality was 52%, and IABP was not associated with reduced 30-day mortality compared with no IABP (risk reduction −1.1%, 95% confidence interval −15.7 to 13.5). IABP use was associated with more in-hospital complications (reported increase 26.1%, 95% confidence interval 15.2–36.8), although the observational design limits causal interpretation.
This registry analysis found no clear mortality advantage associated with IABP and a signal for increased in-hospital complications. Wide mortality confidence intervals leave substantial uncertainty about benefit or harm.
Study limitation: Instrumental-variable adjustment cannot establish randomization, and the wide mortality confidence interval limits precision.
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