Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
Int J Artif Organs. 2022 Jan;45(1):68-74. doi: 10.1177/0391398821991155. Epub 2021 Feb 2.
In patients treated for refractory cardiogenic shock (RCS) following acute myocardial infarction (AMI), predicting successful weaning from veno-arterial extracorporeal membrane oxygenation (VA ECMO) has important implications for decision-making and prognosis.
We performed a retrospective review of adult VA ECMO patients with RCS complicating AMI at our institution from 2010 to 2019. We evaluated use of peak troponin I as a predictor of successful decannulation.
Sixty-two patients were analyzed; mean age 61.1 ± 9.8 years, 73% males, 62% presented with STEMI. Forty-five patients were successfully weaned (group I). Seventeen patients did not wean (group II); seven patients received a durable LVAD, 10 died. Patients from group I had significantly lower peak troponin I (89 vs 434 ng/mL, = 0.0001). Receiver operating characteristic curves showed a peak troponin I cutoff of 400 ng/mL correctly classified patients by weaning status 90% of the time, with associated sensitivity of 71% and specificity of 98%. With each 50 ng/mL increase in troponin I, the likelihood of weaning decreased by 33%.
Peak troponin I above 400 ng/mL may be helpful in predicting unsuccessful weaning from VA ECMO support for refractory cardiogenic shock following myocardial infarction and facilitate triage decisions regarding need for advanced therapies.
在因急性心肌梗死（AMI）导致难治性心源性休克（RCS）而接受治疗的患者中，成功预测脱离静脉-动脉体外膜肺氧合（VA ECMO）支持对决策和预后具有重要意义。
我们对 2010 年至 2019 年在我院因 AMI 并发 RCS 接受 VA ECMO 治疗的成年患者进行了回顾性分析。我们评估了肌钙蛋白 I 峰值作为成功拔管预测因子的作用。
共分析了 62 例患者，平均年龄为 61.1±9.8 岁，73%为男性，62%为 ST 段抬高型心肌梗死。45 例患者成功撤机（I 组）。17 例患者未能撤机（II 组）；7 例患者植入了耐久性左心室辅助装置，10 例患者死亡。I 组患者的肌钙蛋白 I 峰值显著较低（89 与 434ng/mL，=0.0001）。ROC 曲线显示，肌钙蛋白 I 峰值 cutoff 值为 400ng/mL 时，可 90%正确分类患者的撤机状态，其敏感性为 71%，特异性为 98%。肌钙蛋白 I 每增加 50ng/mL，撤机的可能性就会降低 33%。
肌钙蛋白 I 峰值>400ng/mL 可能有助于预测因心肌梗死后难治性心源性休克而接受 VA ECMO 支持的患者无法成功撤机，并有助于决定是否需要进行高级治疗。
