The value of early VA-ECMO support in the perioperative period of emergency percutaneous coronary intervention
Objective To investigate the effect of different timing of arterial-venous extracorporeal membrane oxygenation(VA-ECMO)on the prognosis of patients with acute myocardial infarction complicated with cardiogenic shock(AMICS).Methods This study was a prospective cohort study.AMICS patients received VA-ECMO support primary percutaneous coronary intervention in Henan Provincial People's Hospital from May 2017 to July 2023 were divided into early VA-ECMO group and late VA-ECMO group.64 AMICS patients who met the indications for VA-ECMO implantation,but did not revive VA-ECMO were included as control group.Demographic characteristics,coronary interventional(PCI)information and complications after VA-ECMO implantation were collected.The primary end points was 1-year survival,minor end point were in-hospital and perioperative death.Multivariate Logistic and Cox regression models were used to evaluate the effect of timing of VA-ECMO on prognosis of AMICS patients.Kaplan-Meier survival curve was used to analyze the 1-year survival outcome of the 3 groups.Results A total of 143 AMICS patients were included,and materials of 136 patients entered in the final analysis,including 42 in the early VA-ECMO group,34 in the late VA-ECMO group,and 60 in the non-VA-ECMO group.Compared with the late VA-ECMO group,the early VA-ECMO group had a higher ratio of PPCI after VA-ECMO,a longer D-to-B time,a shorter VA-ECMO support time,a higher success rate of VA-ECMO withdrawal,and a lower complication rate(all P＜0.05).Compared with the early VA-ECMO group,the perioperative,in-hospital and 1-year mortality were significantly higher in Non-ECMO support(all P＜0.05).There was no difference in perioperative and in-hospital mortality between the early VA-ECMO group and the late VA-ECMO group,but the 1-year mortality in the late VA-ECMO group was significantly higher(P＜0.05).Perioperative,in-hospital and 1-year mortality rates were lower in the late VA-ECMO group than in the no-VA-ECMO group,but the differences were not statistically significant.Multivariate Logistic and Cox regression analysis showed that after adjusting interference factors,early VA-ECMO was still a protective factor for in-hospital(OR=0.244,P=0.015)and one year(HR=0.308,P=0.001)mortality.Kaplan-Merier survival curve showed that compared with the late VA-ECMO group and the group without VA-ECMO,the early VA-ECMO group had the highest 1-year survival rate.Conclusion Patients with AMICS may benefit more from early VA-ECMO than from late VA-ECMO support for PPCI.
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