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Introduction Utilisation of MCS (mechanical circulatory support) devices in CS remains controversial. IABP is the most used MCS device for hemodynamic support in CS due to its relative ease of use and safety. Notable trials, including IABP shock I and II trials, have found no mortality benefit for routine use in CS, leading to a level 3 recommendation (not recommended) in the ESC guidelines. Additionally, there is a marked paucity of literature assessing outcomes of MCS utilisation in non-AMI CS.This study evaluates IABP outcomes in CS patients, classified by phenotypical aetiology, at a high-volume heart attack centre (HAC) in the UK.Methods A retrospective observational study was conducted on patients with CS who underwent IABP insertion at the Essex Cardiothoracic Centre (CTC), a high-volume HAC (January 2020-August 2020). SCAI grade, revascularisation outcomes and time from CS onset to IABP insertion were calculated. SCAI grade was classified as low (A-C), intermediate (D) and high (E). Patients were classified based on CS aetiology (AMI/Non-AMI). Primary end-point was 30-day mortality. Data was analysed using binominal logistic regression.Results Essex CTC identified and treated 50 patients with CS who underwent IABP insertion (median age 68yrs±10.2, 58% male). Of these, 84% were in AMI setting. 73.1% underwent successful IRA (infarct related artery) revascularisation on index procedure, 36.7% survived to discharge and 38% had an AMI mechanical complication (papillary muscle rupture, ventricular septal defect or free wall rupture).Higher SCAI grade (SE0.12, 95% CI: 0.11–0.59, p<0.006) correlated with increased 30 day mortality: 33.3% (low), 71.4% (intermediate) and 100% (high) (figure 1).Other independent variables associated with 30-day mortality included:Late presentation AMI (>6h from symptom onset) (SE0.14, 95% CI: 0.001–0.56, p=0.049)Worsening hemodynamic status within the first 48 hours following IABP insertion, defined as an increased requirement for vasopressor support or an inability to maintain a SBP greater than 90mmHg without escalation of vasopressor support (SE0.15, 95% CI:0.32–0.93, p<0.001))Variables not independently associated with 30-day mortality included:Phenotypical aetiology of CS (AMI vs Non AMI) (SE0.19, 95% CI: -0.19–0.56, p=0.33)In AMI aetiology of CS, successful IRA revascularisation on index procedure (SE0.17, 95% CI: -0.52–0.18, p=0.34)Early IABP insertion (<6h from CS onset (SE0.15, 95% CI: -0.58–0.03, p=0.071)Conclusion IABP use in clinical practice continues to be widespread despite major trials and guidelines downgrading its recommended use. This study reinforces the lack of evidence supporting its routine use in CS. Irrespective of aetiology, CS patients who present earlier and demonstrate early improvement in shock parameters have better prognostic outcomes. Early recognition and treatment of AMI and CS remain pivotal to improving outcomes.Abstract 406 Figure 130-day mortality stratified by SCAI risk category