Abstract 8521: Early Extracorporeal Membrane Oxygenator-Assisted Primary Percutaneous Coronary Intervention Improved 30-Day Clinical Outcomes in Patients with STEMI Complicated with Profound Cardiogenic Shock

Abstract

Objectives: This study tested the hypothesis that early extracorporeal membrane oxygenator (ECMO) offered additional benefits in improving 30-day outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) complicated with profound cardiogenic shock undergoing primary percutaneous coronary intervention (PCI). Methods: Between May 1993 and July 2002, 920 acute STEMI patients underwent primary PCI. Of these patients, 12.5% (115) with cardiogenic shock were enrolled into this study (Group 1). Between August 2002 and December 2009, 1650 acute STEMI patients underwent primary PCI. Of these patients, 13.3% (219) complicated with cardiogenic shock were enrolled (Group 2). Results: Incidence of profound shock [defined as systolic blood pressure remained ≤ 75 mmHg after intra-aortic balloon pump and inotropic agent supports] was similar in both groups (21.7% vs. 21.0%, p>0.5). ECMO support, which was only available for group 2 patients, was performed at catheterization room. The results demonstrated that final thrombolysis in myocardial infarction (TIMI)-3 flow in infarct-related artery was similar between the two groups (p=0.678). However, total 30-day mortality and the mortality of profound shock patients were lower in group 2 than in group 1 (all p <0.04). Additionally, the hospital-survival time was remarkably longer in group 2 than in group 1 patients (p=0.0005). Moreover, multivariate analysis demonstrated that unsuccessful reperfusion, presence of advanced congestive heart failure, profound shock, and age were independent predictors of 30-day mortality (all p<0.02). Conclusion: Early ECMO-assisted primary PCI improved 30-day outcomes in STEMI patients complicated with profound cardiogenic shock (The following figure is the detailed schematic presentation of the enrollment status of the patients and their clinical outcome).