For decades, the intra-aortic balloon pump (IABP) has been a reliable and readily available pillar of therapy for cardiogenic shock (CS). However, no clinical markers have been validated that signal sufficient contractile reserve to support recovery with native heart function in this population of patients. Our aim was to assess clinical and hemodynamic predictors of survival to hospital discharge with native recovery.

We retrospectively evaluated 267 consecutive patients who presented with CS to our institution between January 2021 and November 2024 and required IABPs. Hemodynamic variables were captured at 3 different timepoints: baseline (prior to IABP insertion), initial set on support, and final set on support. A total of 80 patients were included in the final analysis. We defined the assisted aortic pulsatility index (API) as assisted systolic blood pressure-assisted diastolic blood pressure/pulmonary capillary wedge pressure (PCWP) by using data extracted from the IABP waveform. In-hospital mortality rates were 31%. Of the remainder, 40% survived to native recovery, and 29% were bridged to either transplantation or an acute or durable left ventricular assist device. Multivariable analysis identified final assisted API and acute myocardial infarction (AMI) presentation as significant predictors of survival to native recovery (final assisted API: 3.283 [1.688, 7.892]; P = 0.002; AMI presentation: 18.12 [2.121, 263.9]; P = 0.016). A receiver-operating characteristic curve was generated using the final assisted API as a predictor of the primary outcome (C-statistic: 0.77; P < 0.001). Using a final assisted API cutoff of > 1.7, this threshold was 81% sensitive and 64% specific for predicting survival to native recovery.

Assisted API, a novel hemodynamic marker calculated as assisted systolic-assisted diastolic blood pressure/PCWP, was a sensitive and specific predictor of survival to native recovery in patients with CS supported by IABPs.