Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock

Nai-Wen Tsao, Chun-Ming Shih, Jong Shiuan Yeh, Yung Ta Kao, Ming-Hsiung Hsieh, Keng-Liang Ou, Jaw Wen Chen, Kou-Gi Shyu, Zen-Chung Weng, Nen-Chung Chang, Feng-Yen Lin, Chun-Yao Huang

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Abstract

Purpose: The aim of this study was to evaluate the impact of extracorporeal membrane oxygenation (ECMO) assistance on the clinical outcome of patients with acute myocardial infarction (AMI) that is complicated by profound cardiogenic shock (CS) who received primary percutaneous coronary intervention (PCI). Materials and Methods: We collected patients from January 2004 through December 2006 (stage 1); 25 patients who presented with AMI and received primary PCI and had profound CS were enrolled in the study. Intraaortic balloon counterpulsation (IABP) was the only modality for extracorporeal support in our hospital. From January 2007 through December 2009 (stage 2), 33 patients who presented with AMI and received primary PCI and had profound CS were enrolled; for this stage; both intra-aortic balloon counter-pulsation and ECMO support were available in our facility. Results: A Kaplan-Meier survival analysis displayed significantly improved survival for patients in stage 2 (P = .001; 1-year survival in stage 1 vs 2; 24% vs 63.64%). Patients presenting with either STEMI (ST segment elevation myocardial infarction) or NSTEMI (Non-ST segment elevation myocardial infarction) benefited from ECMO-assisted PCI (P <.05). In stage 1, patients with refractory ventricular tachycardia/ventricular fibrillation had a very low survival rate; however, in stage 2, the survival rate of patients with and without refractory ventricular tachycardia/ventricular fibrillation was similar (P = .316). Conclusion: Extracorporeal membrane oxygenation-assisted PCI for patients with AMI that is complicated by profound CS may improve the 30-day and 1-year survival rates.

Original languageEnglish
JournalJournal of Critical Care
Volume27
Issue number5
DOIs
Publication statusPublished - Oct 2012

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Keywords

  • Acute myocardial infarction
  • Cardiogenic shock
  • Extracorporeal membrane oxygenation
  • Percutaneous coronary intervention

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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