Zifeng Zeng,1,2 Rongtai Luo,1,2 Xinping Lan1,2 

1Center for Cardiovascular Diseases, Meizhou Academy of Medical Sciences, Meizhou People’s Hospital, Meizhou, People’s Republic of China; 2Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People’s Hospital, Meizhou, People’s Republic of China

Correspondence: Xinping Lan, Center for Cardiovascular Diseases, Meizhou Academy of Medical Sciences, Meizhou People’s Hospital, Meizhou, People’s Republic of China, Email lan-xinping@163.com

Background: The renal safety and cardiovascular outcomes of intra-aortic balloon pump (IABP) support during percutaneous coronary intervention (PCI) in patients with renal dysfunction remain controversial.
Objective: To investigate the effects of IABP on renal function and major adverse cardiovascular events (MACEs) in PCI patients with renal dysfunction, and to establish an individualized prognostic prediction model.
Methods: In this retrospective cohort study, 253 PCI patients with renal dysfunction from Meizhou People’s Hospital (January-December 2023) were analyzed. Propensity score matching (1:4 IABP/non-IABP) balanced baseline characteristics. Least absolute shrinkage and selection operator (LASSO) regression identified predictors for MACEs, followed by nomogram development and validation.
Results: Post-matching (IABP = 16, non-IABP = 64), despite higher baseline risk in the IABP group, no intergroup differences occurred in postoperative creatinine, eGFR, or MACEs incidence (all P > 0.05). However, this group exhibited greater eGFR decline from baseline. Multivariate analysis identified five independent MACEs predictors: preoperative B-type natriuretic peptide (BNP), postoperative BNP, preoperative neutrophil-to-lymphocyte ratio (NLR), postoperative blood urea nitrogen (BUN), and prealbumin levels. The prediction model achieved AUCs of 0.869 ( 95% CI: 0.774– 0.964) and 0.843 ( 95% CI: 0.678– 1.000) in training and validation sets, with decision curve analysis confirming clinical utility at 10%– 80% risk thresholds.
Conclusion: IABP may exacerbate subclinical renal injury in PCI patients with renal dysfunction without mitigating MACEs risk. The validated nomogram provides individualized risk stratification to guide clinical management.

Keywords: intra-aortic balloon pump, renal dysfunction, percutaneous coronary intervention, prognostic model, propensity score matching, major adverse cardiovascular events