Long‐Term Outcomes of Patients Undergoing Extracorporeal Membrane Oxygenator‐Assisted High‐Risk Percutaneous Coronary Intervention

Background Data regarding the long‐term outcomes of patients undergoing venoarterial extracorporeal membrane oxygenator (VA‐ECMO) assisted high‐risk percutaneous coronary intervention (PCI) and the impact of the operator experience is limited. Aims We aimed to investigate the long‐term outcomes of patients undergoing VA‐ECMO‐assisted PCI and the effect of the operator experience. Methods The study was a retrospective cohort study that consecutively enrolled patients who were declined by the Heart Team for coronary artery bypass grafting (CABG) due to high surgical risk and treated with VA‐ECMO‐assisted PCI from November 1, 2016, to March 1, 2024, in Xijing Hospital, China. The primary endpoint was all‐cause death at 1 year. Results A total of 220 patients were included. The mean age ± SD was 65.6 ± 11.4 years and the median LVEF% (IQR) was 36.0 (30.0−40.0). The mean ± SD of the SYNTAX score was 34.7 ± 6.9. The median (IQR) follow‐up was 1.9 (1.3−4.9) years, and the vital status of all patients was available at 1 year. The all‐cause death occurred in 56 (25.5%) of patients at 1 year. Utilizing the restricted cubic spline, the threshold to categorize an experienced operator was performing > 10 cases of VA‐ECMO‐assisted PCI. Compared to the ≤ 10 cases group, the > 10 cases group was associated with a 44% decrease in risk of all‐cause death (19.8% vs. 31.5%, HR adjusted: 0.56, 95% CI: 0.33−0.97, p = 0.039). Conclusion VA‐ECMO‐assisted PCI appeared to be a feasible option for patients unsuitable for CABG. Performing > 10 cases could be a threshold to categorize an experienced operator. Trial Registration: ClinicalTrials.gov identifier: NCT06713876.