The survival of subjects with postmyocardial infarction cardiogenic
shock treated with intra-aortic balloon pumping (IABP) differs
significantly among various reports. Differences in the criteria for
IABP application and in the timing of its initiation have been
considered as the main reasons for variations in survival. This study
examines whether the way patients in cardiogenic shock are treated prior
to IABP may affect their survival. Fifty-five patients in severe
postmyocardial infarction cardiogenic shock were classified into three
groups according to the rate of dobutamine infusion prior to IABP: the
‘’nondobutamine” (group A, n = 31), the ‘’high-dose dobutamine” (8 to
20 mug-kg-1.min-1, group B, n = 17), and the ‘’low-dose dobutamine” (up
to 7 mug-kg-1 -min-1, group C, n = 7). All subjects seen from 1978 to
1983 were recruited for group A, from 1986 to 1990 for group B, and in
years 1984, 1985, and 1991 for group C, without using any other
classification criteria. It was shown a posteriori that the three groups
did not differ in the features of the subjects, in the severity of
shock, and in the time length between onset of shock and pumping
initiation. None of the 17 subjects of group B could survive under
pumping, while 10 of the 31 subjects in group A and 4 of the 7 subjects
in group C were weaned off pumping.
Conclusions: A protracted, high-dose pre-IABP administration of
dobutamine may adversely affect the survival of patients with
postmyocardial infarction cardiogenic shock
