Key result
ECMO-supported PCI was successfully performed in all patients with stable multivessel coronary artery disease, though long-term MACE with fatal outcomes occurred in 23.1% at 12 months.
Why the study?
The study was conducted to analyze in-hospital and long-term results of PCI supported by ECMO in patients with stable multivessel CAD and to justify this approach.
Does percutaneous coronary intervention supported by extracorporeal membrane oxygenation improve outcomes in patients with stable multivessel coronary artery disease and low left ventricular ejection fraction?
Observational (n=13)
Does percutaneous coronary intervention supported by extracorporeal membrane oxygenation improve outcomes in patients with stable multivessel coronary artery disease and low left ventricular ejection fraction?
In a small cohort of patients with stable multivessel CAD and low LVEF, ECMO-supported PCI was feasible but associated with high rates of major bleeding and long-term fatal outcomes.
Urges clinical caution with this approach; leaves open net benefit and safety pending larger RCTs.
Aim. To analyze in-hospital and long-term (12 months) results of percutaneous coronary intervention (PCI) supported by extracorporeal membrane oxygenation (ECMO) in patients with stable coronary heart disease and multivessel coronary artery disease, and to justify the use of such approach in the treatment of this group of patients. Methods. The retrospective analysis included 13 patients with stable coronary artery and multivessel coronary disease. The mean SYNTAX score before the intervention was 31.4±10.8. Between 30 days and 12 months in the postoperative period, the frequency and type of the following major adverse cardiovascular events (MACE) was assessed: all-cause death, myocardial infarction, stroke, repeat revascularization. Twelve months after the event, the data on the frequency and type of adverse cardiovascular events were collected by means of telephone follow-up. Results. Coronary intervention supported by ECMO was performed in all patients. 8 (61.6%) patients required an open surgical approach for ECMO cannula insertion. Door to balloon time was 109.6±79.2 minutes. The mean duration of ECMO support was 101.7±45.4 minutes. Haemodynamic instability, abnormalities in pulmonary gas exchange and rhythm disturbances were not revealed during primary PCI, making it possible to wean off the ECMO post-PCI. The mean residual SYNTAX score was 9.3±11.8. BARC class ≥3 bleeding complications were observed in 6 of 13 patients. Long-term major adverse cardiovascular events with fatal outcomes occurred in 3 (23.1%) patients. Conclusion. Supporting high-risk PCI with ECMO in patients with stable coronary artery disease, multivessel coronary artery disease and low left ventricular ejection fraction made it possible to successfully perform the intervention in all patients. Nevertheless, the long-term (12 months) results show a high percentage of recurrent myocardial infarction, which can be associated with high residual SYNTAX score.
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Верещагин et al. (2021) conducted an observational in Stable coronary heart disease and multivessel coronary artery disease (n=13). Percutaneous coronary intervention supported by extracorporeal membrane oxygenation (ECMO) was evaluated on Major adverse cardiovascular events (all-cause death, myocardial infarction, stroke, repeat revascularization). ECMO-supported PCI was successfully performed in all patients with stable multivessel coronary artery disease, though long-term MACE with fatal outcomes occurred in 23.1% at 12 months.
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