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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Extracorporeal Membrane Oxygenation
Cardiogenic Shock
Percutaneous Coronary Intervention
Myocardial Infarction
Survival
Survival Rate
Ventricular Fibrillation
Ventricular Tachycardia
Counterpulsation
Kaplan-Meier Estimate
Survival Analysis

Keywords

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

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

@article{dc62044ae54349698b4c361bb0f643a5,
title = "Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock",
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.",
keywords = "Acute myocardial infarction, Cardiogenic shock, Extracorporeal membrane oxygenation, Percutaneous coronary intervention",
author = "Nai-Wen Tsao and Chun-Ming Shih and Yeh, {Jong Shiuan} and Kao, {Yung Ta} and Ming-Hsiung Hsieh and Keng-Liang Ou and Chen, {Jaw Wen} and Kou-Gi Shyu and Zen-Chung Weng and Nen-Chung Chang and Feng-Yen Lin and Chun-Yao Huang",
year = "2012",
month = "10",
doi = "10.1016/j.jcrc.2012.02.012",
language = "English",
volume = "27",
journal = "Journal of Critical Care",
issn = "0883-9441",
publisher = "Elsevier BV",
number = "5",

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TY - JOUR

T1 - Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock

AU - Tsao, Nai-Wen

AU - Shih, Chun-Ming

AU - Yeh, Jong Shiuan

AU - Kao, Yung Ta

AU - Hsieh, Ming-Hsiung

AU - Ou, Keng-Liang

AU - Chen, Jaw Wen

AU - Shyu, Kou-Gi

AU - Weng, Zen-Chung

AU - Chang, Nen-Chung

AU - Lin, Feng-Yen

AU - Huang, Chun-Yao

PY - 2012/10

Y1 - 2012/10

N2 - 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.

AB - 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.

KW - Acute myocardial infarction

KW - Cardiogenic shock

KW - Extracorporeal membrane oxygenation

KW - Percutaneous coronary intervention

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U2 - 10.1016/j.jcrc.2012.02.012

DO - 10.1016/j.jcrc.2012.02.012

M3 - Article

VL - 27

JO - Journal of Critical Care

JF - Journal of Critical Care

SN - 0883-9441

IS - 5

ER -