Clinical Characteristics and Outcomes in Intra-aortic Balloon Pump–Supported Cardiogenic Shock Among Patients Transferred to Tertiary Care Centers

Background The intra-aortic balloon pump (IABP) is a commonly used temporary mechanical circulatory support device in cardiogenic shock (CS). A substantial proportion of patients receive IABP at referring hospitals prior to transfer. The aim of this study was to compare clinical characteristics, treatment strategies, and outcomes between transferred and nontransferred IABP-treated patients with all-cause CS, acute myocardial infarction–related CS (AMI-CS), and heart failure–related CS (HF-CS). Methods Intra-aortic balloon pump–treated CS patients from the multicenter Cardiogenic Shock Working Group registry (2020-2024) were analyzed. Adjusted logistic regression models were used to assess associations between transfer status and in-hospital mortality, native heart survival, heart replacement therapies, and in-hospital complications. Results Among 2112 IABP-treated patients (36.6% AMI-CS, 48.9% HF-CS), 652 (30.9%) were primarily treated at referring centers and transferred. Transferred patients more frequently had AMI-CS (57.8% vs 27.1%) and less often HF-CS (27.5% vs 58.4%) than nontransferred subjects. Transfer was associated with higher in-hospital mortality (33.1% vs 26.4%; adjusted odds ratio [aOR], 1.38; 95% CI, 1.13-1.68; P < .001), with the strongest association observed in non–AMI-CS/non–HF-CS (40.6% vs 28.3%; aOR, 1.73; 95% CI, 1.07-3.04; P = .026). Complications were linked to transfer status, including stroke (aOR, 1.83; 95% CI, 1.30-2.57; P < .001), limb ischemia (aOR, 2.17; 95% CI, 1.53-3.09; P < .001), and in-hospital cardiac arrest (aOR, 1.37; 95% CI, 1.08-1.72; P = .006). Conclusions Transfer status was independently associated with higher in-hospital mortality and complications. These findings emphasize the importance of structured referral pathways and heightened awareness at hub centers for this potentially high-risk IABP-treated CS cohort.