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

Sheng Ying Chung, Meng Shen Tong, Jiunn Jye Sheu, Fan Yen Lee, Pei Hsun Sung, Chien Jen Chen, Cheng Hsu Yang, Chiung Jen Wu, Hon Kan Yip*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

50 Scopus citations

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.

Original languageEnglish
Pages (from-to)412-417
Number of pages6
JournalInternational Journal of Cardiology
Volume223
DOIs
StatePublished - 15 11 2016

Bibliographical note

Publisher Copyright:
© 2016 Elsevier Ireland Ltd

Keywords

  • Extracorporeal membrane oxygenator support
  • Primary percutaneous coronary intervention
  • Profound cardiogenic shock
  • Short-term and long-term outcomes

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