ECMO versus IABP for patients with STEMI complicated by cardiogenic shock undergoing primary PCI: a Chinese National Study and propensity-matched analysis

OBJECTIVE: This study investigated the association between the utilization of extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump (IABP) and in-hospital mortality among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock undergoing primary percutaneous coronary intervention (PCI). METHODS: Data encompassing 9635 cases of STEMI complicated by cardiogenic shock and treated with primary PCI using ECMO/IABP support were retrieved from the Chinese Cardiovascular Association database (2019-2021). We conducted an analysis to assess the in-hospital survival disparities among percutaneous mechanical circulatory device recipients and explore the potential advantages of ECMO through multivariable logistic regression analysis within a propensity score-matched (1:2) cohort population. RESULTS: ECMO was administered to 2028 patients, whereas IABP was used in 7607 patients. Patients supported by ECMO showed a lower in-hospital mortality than those supported by IABP (7.2% versus 15.1%, p < 0.001). Within the propensity-matched (case: control = 1:2) cohort, we noted a 34% reduced risk of in-hospital mortality among patients supported by ECMO compared with those supported by IABP (7.7% versus 11.7%; odds ratio = 0.66; 95% CI, 0.53-0.80; p < 0.001) independent of age, sex, systolic blood pressure, obesity, smoke, hypertension, diabetes, dyslipidemia, family history of coronary artery disease, coronary artery disease, stroke, atrial filiation, peripheral artery disease, chronic kidney disease, vascular lesion sites, 3A-grade hospital, and regional distributions in China. CONCLUSION: Among patients undergoing primary PCI for STEMI complicated by cardiogenic shock, ECMO was associated with better in-hospital survival than IABP.