Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock.

Abstract

OBJECTIVES:

This study tested the hypothesis that early extracorporeal membrane oxygenator offered additional benefits in improving 30-day outcomes in patients with acute ST-segment elevation myocardial infarction complicated with profound cardiogenic shock undergoing primary percutaneous coronary intervention.

METHODS:

Between May 1993 and July 2002, 920 patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention. Of these patients, 12.5% (115) with cardiogenic shock were enrolled in this study (group 1). Between August 2002 and December 2009, 1650 patients with acute ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention. Of these patients, 13.3% (219) complicated with cardiogenic shock were enrolled (group 2).

RESULTS:

The incidence of profound shock (defined as systolic blood pressure remaining < or =75 mm Hg after intra-aortic balloon pump and inotropic agent supports) was similar in both groups (21.7% vs. 21.0%, p > .5). Extracorporeal membrane oxygenator support, which was available only for patients in group 2, was performed in the catheterization room. The results demonstrated that final thrombolysis in myocardial infarction grade 3 flow in infarct-related artery was similar between the two groups (p = .678). However, total 30-day mortality and the mortality of patients with profound shock were lower in group 2 than in group 1 (all p < .04). Additionally, the hospital survival time was remarkably longer in patients in group 2 than in patients in group 1 (p = .0005). Furthermore, multivariate analysis demonstrated that unsuccessful reperfusion, presence of advanced congestive heart failure, profound shock, and age were independent predictors of 30-day mortality (all p < .02).

CONCLUSION:

Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day outcomes in patients with ST-segment elevation myocardial infarction with complicated with profound cardiogenic shock.

• Authors: Jiunn-Jye Sheu, Tzu-Hsien Tsai, Fan-Yen Lee, Hsiu-Yu Fang, Cheuk-Kwan Sun, Steve Leu, Cheng-Hsu Yang, Shyh-Ming Chen, Chi-Ling Hang, Yuan-Kai Hsieh, Chien-Jen Chen, Chiung-Jen Wu, Hon-Kan Yip
• Journal: Critical care medicine (Crit Care Med) Vol. 38 Issue 9 Pg. 1810-7 (Sep 2010) ISSN: 1530-0293 [Electronic] United States
• PMID: 20543669 (Publication Type: Journal Article)

Topics

• Aged
• Angioplasty, Balloon, Coronary
• Electrocardiography
• Extracorporeal Membrane Oxygenation
• Female
• Humans
• Male
• Middle Aged
• Myocardial Infarction (complications, surgery)
• Shock, Cardiogenic (complications)
• Treatment Outcome