Short-term and long-term prognostic outcomes of patients with ST-segment elevation myocardial infarction complicated by profound cardiogenic shock undergoing early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention

• Published in: International journal of cardiology 2016-11, Vol.223, p.412-417
• Main Authors: Chung, Sheng-Ying, Tong, Meng-Shen, Sheu, Jiunn-Jye, Lee, Fan-Yen, Sung, Pei-Hsun, Chen, Chien-Jen, Yang, Cheng-Hsu, Wu, Chiung-Jen, Yip, Hon-Kan
• Format: Article
• Language: English
• Subjects: Cardiovascular; Extracorporeal Membrane Oxygenation - methods; Extracorporeal membrane oxygenator support; Female; Follow-Up Studies; Humans; Male; Middle Aged; Percutaneous Coronary Intervention - methods; Primary percutaneous coronary intervention; Profound cardiogenic shock; Prognosis; Retrospective Studies; Shock, Cardiogenic - etiology; Shock, Cardiogenic - mortality; Shock, Cardiogenic - therapy; Short-term and long-term outcomes; ST Elevation Myocardial Infarction - complications; ST Elevation Myocardial Infarction - mortality; ST Elevation Myocardial Infarction - surgery; Survival Rate - trends; Taiwan - epidemiology; Time Factors
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2016.08.068

Abstract Background This study investigated the 30-day and long-term prognostic outcomes in patients with ST-segment elevation myocardial infarction (STEMI) complicated with profound cardiogenic shock (CS) undergoing early routine extracorporeal membrane oxygenator (ECMO)-assisted primary percutaneous coronary intervention (PCI). Methods Between December 2005 and December 2014, 65 consecutive STEMI patients with profound CS underwent routine ECMO-supported primary PCI. Results The incidences of acute pulmonary edema, respiratory failure with requirement of mechanical ventilatory support upon presentation, and 30-day mortality rate were 100%, 95.4%, and 43.1%, respectively. The duration of hospitalization, mean long-term follow-up, and survival rate were 32.1 ± 53.1 (days), 733.6 ± 986.7 (days), and 32.3%, respectively. The mean APACHE score (32.6 ± 8.3 vs. 28.5 ± 7.5), peak serum creatinine level (4.3 ± 2.4 vs. 1.7 ± 1.2 mg/dL), incidences of failed ECMO weaning (57.1% vs. 0%), successful ECMO weaning but in-hospital death (40.0% vs. 0%) were significantly lower in 30-day survivors than those in non-survivors (all p < 0.05), whereas final thrombolysis in myocardial infarction (TIMI)-3 flow [53.6% vs. 91.9%] showed an opposite pattern compared to that of APACHE score in the two groups ( p < 0.02). Multivariate analysis demonstrated that unsuccessful reperfusion, failed ECMO weaning, and peak creatinine level were independent predictors of 30-day mortality (all p < 0.01). Conclusions Early ECMO-supported primary PCI in STEMI patients with profound CS was feasible as a life-saving strategy with acceptable 30-day and long-term prognostic outcomes.