The Effect of Percutaneous Coronary Intervention on Patients with Acute Myocardial Infarction and Cardiogenic Shock Supported by Extracorporeal Membrane Oxygenation

Yan Wang; Hongfu Fu; Jin Li; Haixiu Xie; Chenglong Li; Zhongtao Du; Xing Hao; Hong Wang; Liangshan Wang; Xiaotong Hou

doi:10.31083/j.rcm2512449

The Effect of Percutaneous Coronary Intervention on Patients with Acute Myocardial Infarction and Cardiogenic Shock Supported by Extracorporeal Membrane Oxygenation

Rev Cardiovasc Med. 2024 Dec 23;25(12):449. doi: 10.31083/j.rcm2512449. eCollection 2024 Dec.

Authors

Yan Wang¹, Hongfu Fu¹, Jin Li¹, Haixiu Xie¹, Chenglong Li¹, Zhongtao Du¹, Xing Hao¹, Hong Wang¹, Liangshan Wang¹, Xiaotong Hou¹

Affiliation

¹ Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.

Abstract

Background: Patients suffering from acute myocardial infarction complicated by cardiogenic shock (AMICS), who undergo veno-arterial extracorporeal membrane oxygenation (VA-ECMO) therapy, typically exhibit high mortality rates. The benefits of percutaneous coronary intervention (PCI) in these patients remains unclear. This study aims to investigate whether PCI can mitigate mortality among patients with AMICS supported by ECMO.

Methods: Data from patients ≥18 years, who underwent VA-ECMO assistance in China between January 1, 2017, and June 30, 2022, were retrieved by searching the Chinese Society of Extracorporeal Life Support (CSECLS) Registry. A total of 1623 patients were included and categorised based on whether they underwent PCI. Using propensity score matching, 320 patient pairs were successfully matched. The primary outcome was in-hospital mortality rate. The secondary outcomes included VA-ECMO duration, Hospital stay, ECMO weaning and ECMO related complications.

Results: In the cohort of 1623 patients, 641 (39.5%) underwent PCI. Upon conducting multivariate logistic regression analysis, it was observed that those who underwent PCI had a lower prevalence of hyperlipidemia (13.1% versus [vs.] 17.8%), chronic respiratory disease (2.5% vs. 4.3%) and lower lactic acid (5.90 vs. 8.40). They also had a more significant history of PCI (24.8% vs. 19.8%) and were more likely to be smokers (42.6% vs. 37.0%). Patients in the PCI group exhibited lower in-hospital mortality before and after matching (40.3% vs. 51.6%; p = 0.005), which persisted in multivariable modeling (adjusted odds ratio [aOR]: 0.69; 95% confidence interval 0.50-0.95; p = 0.024). Patients who received PCI were more successfully weaned from ECMO (88.6% vs. 75.8% before matching). PCI was not a risk factor for ECMO related complications.

Conclusions: Among patients who received ECMO support for AMICS, PCI was associated with a lower rate of in-hospital mortality.

Keywords: cardiogenic shock; extracorporeal membrane oxygenation; percutaneous coronary intervention.

Grants and funding

This work was supported by the Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support (ZYLX202111, to X Hou), Beijing Hospitals Authority “Ascent Plan” (FDL20190601, to X Hou), National Natural Science Foundation of China (No. 82100408, to X Hao), Beijing Nova Program (No. 20220484043, to C Li), Young Elite Scientists Sponsorship Program by CAST (2022QNRC001, to L Wang), National Natural Science Foundation of China (82200433, to L Wang), and Beijing Hospitals Authority Youth Programme (QML20230602, to L Wang). The National Natural Science Foundation of China (No. 82170400).