Key result
The number of diseased coronary arteries independently predicted 100-day mortality (OR 3.788, P=0.008), and adding angiographic findings to clinical scores improved mortality prediction.
Why the study?
This study aimed to identify the clinical scores and coronary angiographic determinant factors of survival in patients with acute myocardial infarction and refractory cardiogenic shock treated with veno-arterial extracorporeal membrane oxygenation.
Do clinical scores and coronary angiographic factors predict 100-day survival in patients with AMI-related refractory cardiogenic shock treated with VA-ECMO?
Cohort (n=69)
Do clinical scores and coronary angiographic factors predict 100-day survival in patients with AMI-related refractory cardiogenic shock treated with VA-ECMO?
Odds Ratio: 3.788
p-value: p=0.008
The addition of coronary angiographic findings, specifically the number of diseased vessels, to standard clinical scores improves the prediction of 100-day mortality in patients with AMI-related cardiogenic shock treated with VA-ECMO.
May aid prognostication in AMI shock on VA-ECMO; hypothesis-generating and requires prospective validation.
Background: This study aimed to identify the determinant factors of survival in patients with acute myocardial infarction (AMI) and refractory cardiogenic shock (RCS) who underwent veno-arterial extracorporeal membrane oxygenation (ECMO). Methods: Sixty-nine consecutive patients with AMI-related RCS were enrolled in the study. They were treated with ECMO and primary percutaneous coronary intervention (PCI). The clinical scores and coronary angiography (CAG) factors related to 100-day survival were evaluated. Results: Thirty patients (43.5%) survived for more than 100 days. The CAG showed that 19 (27.5%) patients had left main disease (LMD). There were 17 (24.6%), 27 (39.1%), and 25 (36.3%) patients with one-vessel, two-vessel, and three-vessel disease, respectively. There were significant differences between the survivors and non-survivors in the simplified acute physiology score II (SAPSII) (65.4±17.2 vs. 83.1±13.0, P<0.001), sepsis-related organ failure assessment score (SOFA) (10.4±2.7 vs. 12.3±2.5, P=0.004), survival after veno-arterial extracorporeal membrane oxygenation score (SAVE) (−4.4±4.3 vs. −8.4±3.1, P<0.001), CPR time (15.8±16.6 vs. 30.0±29.5, P=0.048), LMD [4 (13.3%) vs. 15 (38.5%), P=0.029], and number of coronary artery disease (NCAD) (P<0.001). Multivariate logistic regression analysis showed that NCAD (OR 3.788, P=0.008) was one of the independent predictors of mortality. The ROC analysis showed that SAPSII (AUC 0.786, P<0.001), SOFA (AUC 0.715, P=0.002), and SAVE (AUC 0.766, P<0.001) equally predict mortality. The combined NCAD parameters more accurately predicted mortality and differences in the AUC values (d-AUC) between SAPSII plus NCAD vs. SAPSII (d-AUC 0.073, z=2.256, P=0.024), SOFA plus NCAD vs. SOFA (d-AUC 0.058, z=2.773, P=0.006), and SAVE plus NCAD vs. SAVE (d-AUC 0.036, z=2.332, P=0.020). Conclusions: The SAPSII, SOFA, and SAVE scores predict the prognosis of ECMO-treated AMI patients with RCS. The CAG findings reinforce the predictive power of each score.
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Kim et al. (2020) conducted a cohort in Acute myocardial infarction-related refractory cardiogenic shock (n=69). Number of coronary artery disease (NCAD) and clinical scores was evaluated on 100-day mortality (OR 3.788, p=0.008). The number of diseased coronary arteries independently predicted 100-day mortality (OR 3.788, P=0.008), and adding angiographic findings to clinical scores improved mortality prediction.
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