Key result
In patients with MI and refractory cardiogenic shock on ECLS, combining an intra-aortic balloon pump with ECLS was independently associated with reduced 30-day mortality (HR 0.48; 95% CI 0.28-0.80; p=0.006).
Why the study?
What are the independent correlates of 30-day survival in patients with refractory cardiogenic shock due to MI requiring ECLS?
Observational (n=106)
No
What are the independent correlates of 30-day survival in patients with refractory cardiogenic shock due to MI requiring ECLS?
Hazard Ratio: 0.48 (95% CI 0.28–0.8)
p-value: p=0.006
In patients with refractory cardiogenic shock complicating MI on ECLS, combining IABP with ECLS improves 30-day survival, whereas early percutaneous revascularization does not appear to impact outcomes.
May support IABP addition to ECLS in MI shock; hypothesis-generating and requires randomized confirmation before practice change.
AIMS: The aim of the study was to identify independent correlates of survival in patients undergoing PCI for refractory cardiogenic shock due to myocardial infarction (RCS-MI) with the need for extracorporeal life support (ECLS). METHODS AND RESULTS: This observational single tertiary centre study enrolled 106 consecutive patients (52.7±10.4 years) with ECLS placed before or after the PCI. Half of the patients had triple vessel disease and PCI was attempted whenever possible (74.5%). The 30-day mortality rate was 63.2%. Left main culprit vessel disease (19% of patients) (adj. HR [95% CI]: 2.31 [1.27-4.18], p=0.006) and sepsis-related organ failure assessment ≥13 (adj. HR 2.17 [1.25-3.75], p=0.005) were independently associated with 30-day mortality. The use of intra-aortic balloon pump (IABP) combined with ECLS was an independent protective factor (adj. HR 0.48 [0.28-0.80], p=0.006). Neither complete (p=0.66) nor successful (p=0.69) myocardial revascularisation was associated with 30-day survival. CONCLUSIONS: RCS in MI patients often reveals a severe multivessel coronary artery disease with no impact of early percutaneous coronary revascularisation on clinical outcome. The survival advantage of IABP when combined with ECLS further suggests that achieving an early effective haemodynamic support should be the major goal in this young patient population.
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Overtchouk et al. (2018) conducted an observational in Refractory cardiogenic shock due to myocardial infarction (RCS-MI) with the need for extracorporeal life support (ECLS) (n=106). Intra-aortic balloon pump (IABP) combined with ECLS vs. ECLS without IABP was evaluated on 30-day mortality (HR 0.48, 95% CI 0.28-0.80, p=0.006). In patients with MI and refractory cardiogenic shock on ECLS, combining an intra-aortic balloon pump with ECLS was independently associated with reduced 30-day mortality (HR 0.48; 95% CI 0.28-0.80; p=0.006).
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