16 ECMO and MCS for patients undergoing PCI: experience from taipei veterans general hospital

Abstract

Intra-aortic balloon pump (IABP), which simultaneously augments coronary blood flow and decreases myocardial oxygen demand, usually provides haemodynamic support in patients with impaired left ventricular function undergoing percutaneous coronary intervention (PCI)1 2 or for patients with established cardiogenic shock.3 Several observational studies have reported that prophylactic IABP insertion could reduce major adverse cardiovascular events (MACE) compared with a provisional counterpulsation strategy during high-risk PCI.4 However, meta-analysis did not reveal a benefit of routine elective use of IABP or percutaneous ventricular assisted device.5 Due to a lack of national data from Taiwan, this presentation therefore summarises the experience at Taipei Veterans General Hospital, and the patients’ clinical characteristics and long-term outcomes including cardiac mortality and MACE associated with high-risk PCI and/or acute myocardial infarction. References Kern MJ, Aguirre F, Bach R, Donohue T, Siegel R, Segal J. Augmentation of coronary blood flow by intra-aortic balloon pumping in patients after coronary angioplasty. Circulation 1993;87:500–511. Cohen M, Urban P, Christenson JT, Joseph DL, Freedman RJ Jr, Miller MF, Ohman EM, Reddy RC, Stone GW, Ferguson JJ 3rd; Benchmark Registry Collaborators. Intra-aortic balloon counterpulsation in US and non-US centres: results of the Benchmark Registry. Eur Heart J 2003;24:1763–1770. Sjauw KD, Engstrom AE, Vis MM, van der Schaaf RJ, Baan J Jr, Koch KT, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP. A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?Eur Heart J 2009;30:459–468. Mishra S, Chu WW, Torguson R, Wolfram R, Deible R, Suddath WO, Pichard AD, Satler LF, Kent KM, Waksman R. Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention. Am J Cardiol 2006;98:608–612. Lee JM, Park J, Kang J, Jeon KH, Jung JH, Lee SE, Han JK, Kim HL, Yang HM, Park KW, Kang HJ, Koo BK, Kim SH, Kim HS. The efficacy and safety of mechanical hemodynamic support in patients undergoing high-risk percutaneous coronary intervention with or without cardiogenic shock: Bayesian approach network meta-analysis of 13 randomized controlled trials. Int J Cardiol2015;184:36–46.