Yan Wang, Hongfu Fu, Jin Li, Haixiu Xie, Chenglong Li, Zhongtao Du, Xing Hao, Hong Wang, Liangshan Wang, Xiaotong Hou
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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.</p><p><strong>Results: </strong>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%; <i>p</i> = 0.005), which persisted in multivariable modeling (adjusted odds ratio [aOR]: 0.69; 95% confidence interval 0.50-0.95; <i>p</i> = 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.</p><p><strong>Conclusions: </strong>Among patients who received ECMO support for AMICS, PCI was associated with a lower rate of in-hospital mortality.</p>","PeriodicalId":20989,"journal":{"name":"Reviews in cardiovascular medicine","volume":"25 12","pages":"449"},"PeriodicalIF":1.9000,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683699/pdf/","citationCount":"0","resultStr":"{\"title\":\"The Effect of Percutaneous Coronary Intervention on Patients with Acute Myocardial Infarction and Cardiogenic Shock Supported by Extracorporeal Membrane Oxygenation.\",\"authors\":\"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\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>In the cohort of 1623 patients, 641 (39.5%) underwent PCI. 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引用次数: 0
摘要
背景：急性心肌梗死并发心源性休克（AMICS）的患者，在接受静脉-动脉体外膜氧合（VA-ECMO）治疗时，通常具有很高的死亡率。经皮冠状动脉介入治疗（PCI）对这些患者的益处尚不清楚。本研究旨在探讨PCI是否能降低ECMO支持下AMICS患者的死亡率。方法：通过检索中国体外生命支持学会（CSECLS）注册表检索2017年1月1日至2022年6月30日期间在中国接受VA-ECMO辅助的≥18岁患者的数据。共纳入1623例患者，并根据是否接受PCI进行分类。使用倾向评分匹配，320对患者成功匹配。主要终点为住院死亡率。次要结局包括VA-ECMO持续时间、住院时间、ECMO脱机和ECMO相关并发症。结果：1623例患者中，641例（39.5%）行PCI。通过多因素logistic回归分析，观察到接受PCI的患者高脂血症患病率较低（13.1% vs. 17.8%），慢性呼吸系统疾病患病率较低（2.5% vs. 4.3%），乳酸水平较低（5.90 vs. 8.40）。他们也有更显著的PCI病史（24.8%对19.8%），更有可能是吸烟者（42.6%对37.0%）。PCI组患者匹配前后的住院死亡率较低(40.3% vs 51.6%；p = 0.005)，这在多变量模型中仍然存在(校正优势比[aOR]: 0.69；95%置信区间0.50-0.95；P = 0.024)。接受PCI的患者更成功地脱离了ECMO （88.6% vs.匹配前的75.8%）。PCI不是ECMO相关并发症的危险因素。结论：在接受ECMO支持的AMICS患者中，PCI与较低的住院死亡率相关。
The Effect of Percutaneous Coronary Intervention on Patients with Acute Myocardial Infarction and Cardiogenic Shock Supported by Extracorporeal Membrane Oxygenation.
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.
期刊介绍：
RCM is an international, peer-reviewed, open access journal. RCM publishes research articles, review papers and short communications on cardiovascular medicine as well as research on cardiovascular disease. We aim to provide a forum for publishing papers which explore the pathogenesis and promote the progression of cardiac and vascular diseases. We also seek to establish an interdisciplinary platform, focusing on translational issues, to facilitate the advancement of research, clinical treatment and diagnostic procedures. Heart surgery, cardiovascular imaging, risk factors and various clinical cardiac & vascular research will be considered.
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