Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea.
Korean Circ J. 2011 Jun;41(6):299-303. doi: 10.4070/kcj.2011.41.6.299. Epub 2011 Jun 30.
Percutaneous cardiopulmonary support (PCPS) has proven to be a valuable technique in high-risk coronary patients undergoing percutaneous coronary intervention (PCI). However, there have been few studies on PCI associated with PCPS in Korea. We summarized our experience with PCPS-supported PCI.
We retrospectively reviewed 19 patients with PCPS-supported PCI between August 2005 and June 2009. PCPS was used as an elective procedure for 10 patients with at least two of the following conditions: left-ventricular ejection fraction <35%, target vessel(s) supplying more than 50% of the viable myocardium, high risk surgical patients, and patients who refused coronary bypass surgery. In the remaining 9 patients PCPS was used as an emergency procedure, to stabilize and even resuscitate patients with acute myocardial infarction and cardiogenic shock, in order to attempt urgent PCI.
Among the 19 patients who were treated with PCPS-supported PCI, 11 (57.9%) survived and 8 (42.1%) patients did not. ST elevation myocardial infarction with cardiogenic shock was more prevalent in the non-survivors than in the survivors (75% vs. 27.3%, p=0.04). The elective PCPS-supported PCI was practiced more frequently in the survivors than in the non-survivors (72.7% vs. 25%, p=0.04). In the analysis of the event-free survival curve between elective and emergency procedures, there was a significant difference in the survival rate (p=0.025). Among the survivors there were more patients with multi-vessel disease, but a lower Thrombolysis in Myocardial Infarction grade in the culprit lesions was detected in the non-survivors, before PCI. Although we studied high-risk patients, there was no procedure-related mortality.
Our experience suggests that PCPS may be helpful in high risk patients treated with PCI, especially in elective cases. More aggressive and larger scale studies of PCPS should follow.
经皮心肺支持（PCPS）已被证明是高危冠状动脉患者行经皮冠状动脉介入治疗（PCI）的一种有价值的技术。然而，在韩国，关于与 PCPS 相关的 PCI 的研究很少。我们总结了我们在 PCPS 支持 PCI 方面的经验。
我们回顾性分析了 2005 年 8 月至 2009 年 6 月期间 19 例接受 PCPS 支持的 PCI 患者。PCPS 作为一种选择性手术，用于以下至少两种情况的 10 例患者：左心室射血分数<35%，靶血管（多个）供应超过 50%的存活心肌，高危手术患者，以及拒绝冠状动脉旁路手术的患者。在其余 9 例患者中，PCPS 作为紧急手术使用，以稳定甚至复苏急性心肌梗死和心源性休克患者，以便尝试紧急 PCI。
在接受 PCPS 支持的 PCI 治疗的 19 例患者中，11 例（57.9%）存活，8 例（42.1%）患者死亡。ST 段抬高型心肌梗死合并心源性休克的患者在非幸存者中比在幸存者中更为常见（75% vs. 27.3%，p=0.04）。幸存者中接受选择性 PCPS 支持的 PCI 的比例高于非幸存者（72.7% vs. 25%，p=0.04）。在对选择性和紧急手术的无事件生存曲线进行分析时，生存率存在显著差异（p=0.025）。在幸存者中，多支血管疾病的患者更多，但在 PCI 前，非幸存者的罪犯病变中的血栓溶解分级较低。尽管我们研究了高危患者，但没有发生与手术相关的死亡。
我们的经验表明，PCPS 可能对接受 PCI 治疗的高危患者有帮助，特别是在选择性病例中。应该进行更积极和更大规模的 PCPS 研究。
