High-Risk Factors of In-Hospital Death Following Complex High-risk and Indicated Patients After Percutaneous Coronary Intervention Supported by Extracorporeal Membrane Oxygenation.

Background: Complex high-risk and indicated patients (CHIPs) increase the risk of in-hospital death after percutaneous coronary intervention (PCI). Extracorporeal membrane oxygenation (ECMO) support can improve survival. However, there remains a gap in knowledge regarding how to identify and manage these high-risk patients effectively to reduce mortality. This study aimed to determine the independent high-risk factors associated with increased risk of in-hospital mortality among CHIPs after PCI with ECMO support. This research focused on providing clinicians with more accurate risk assessment tools for devising more effective treatment plans for these patients.

Methods: The EMBASE, PubMed, Cochrane Library, Web Of Science, Chinese Biomedical Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang databases were searched from their inception to October 1, 2024, to identify observational studies examining mortality risk amongst adult CHIPs (age ≥18 years). The primary outcome was in-hospital mortality. A meta-analysis used random-effects models to obtain summary odds ratios (ORs) with 95% confidence intervals (CIs). The Cochrane risk-of-bias tool assessed the quality of evidence.

Results: Ten studies with 306 participants were included. In pooled analyses, cardiogenic shock (CS) or cardiac arrest (CA) to ECMO (mean difference (MD) : 34.61, 95% confidence interval (CI): 26.70 to 42.52; p < 0.00001), ECMO duration (MD : -19.93, 95% CI: -32.85 to -7.02; p = 0.002), type of infarction-associated coronary artery-left anterior descending (LAD; OR : 3.16, 95% CI: 1.83 to 5.47; p < 0.0001), body mass index (BMI; MD: 1.52, 95% CI: 1.06 to 1.97; p < 0.00001), lactate levels (MD: 3.15, 95% CI: 2.37 to 3.94; p < 0.00001), left ventricle ejection fraction (LVEF; MD: -4.09, 95% CI: -6.17 to -2.00; p = 0.0001), mean arterial pressure (MAP; MD: -24.92, 95% CI: -32.19 to -17.65; p < 0.00001), heart rate, male sex, left circumflex, and right coronary artery, were associated with in-hospital mortality.

Conclusions: CHIPs with longer CS or CA to ECMO, shorter ECMO duration, LAD infarction, higher BMI, elevated lactate levels, and lower LVEF and MAP have an increased risk of in-hospital death.