Outcomes of Venoarterial Extracorporeal Membrane Oxygenation Plus Intra-Aortic Balloon Pumping for Treatment of Acute Myocardial Infarction Complicated by Cardiogenic Shock

• Published in: Journal of the American Heart Association 2022-04, Vol.11 (7), p.e023713-e023713
• Main Authors: Nishi, Takeshi, Ishii, Masanobu, Tsujita, Kenichi, Okamoto, Hiroshi, Koto, Satoshi, Nakai, Michikazu, Sumita, Yoko, Iwanaga, Yoshitaka, Matoba, Satoaki, Kobayashi, Yoshio, Hirata, Ken-Ichi, Hikichi, Yutaka, Yokoi, Hiroyoshi, Ikari, Yuji, Uemura, Shiro
• Format: Article
• Language: English
• Subjects: acute myocardial infarction; cardiogenic shock; Extracorporeal Membrane Oxygenation - adverse effects; Humans; Intra-Aortic Balloon Pumping - adverse effects; intra‐aortic balloon pumping; Myocardial Infarction - complications; Myocardial Infarction - therapy; Original Research; Percutaneous Coronary Intervention - adverse effects; Shock, Cardiogenic - etiology; Shock, Cardiogenic - therapy; Treatment Outcome; venoarterial extracorporeal membrane oxygenation
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/jaha.121.023713

Background Clinical outcomes of acute myocardial infarction complicated by cardiogenic shock remain poor with high in-hospital mortality. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been widely used for patients with acute myocardial infarction complicated by cardiogenic shock refractory to conservative therapy, which is likely fatal without mechanical circulatory support. However, whether additional intra-aortic balloon pumping (IABP) use during VA-ECMO support improves clinical outcomes remains controversial. This study sought to investigate prognostic impact of the combined VA-ECMO plus IABP treatment compared with VA-ECMO alone. Methods and Results From the nationwide Japanese administrative case-mix Diagnostic Procedure Combination (DPC), the JROAD (Japanese Registry of All Cardiac and Vascular Diseases)-DPC, we identified 3815 patients with acute myocardial infarction complicated by cardiogenic shock who underwent primary percutaneous coronary intervention and managed with VA-ECMO. Of these, 2964 patients (77.7%) were managed with IABP (VA-ECMO plus IABP), whereas 851 (22.3%) were managed without IABP (VA-ECMO alone). We compared in-hospital, 7-day, and 30-day mortality between the VA-ECMO plus IABP versus the VA-ECMO alone support. Patients managed with VA-ECMO plus IABP demonstrated significantly lower in-hospital, 7-day, and 30-day mortality than those managed with VA-ECMO alone (adjusted odds ratios [95% CI] of 0.47 [95% CI, 0.38-0.59], 0.41 [95% CI, 0.33-0.51], and 0.30 [95% CI, 0.25-0.37], respectively). The findings were consistent in the propensity matching and inverse probability of treatment-weighting models. Conclusions This large-scale, nationwide study demonstrated that the combination of VA-ECMO plus IABP support was associated with significantly lower mortality compared with VA-ECMO support alone in patients presenting with acute myocardial infarction complicated by cardiogenic shock who underwent primary percutaneous coronary intervention.