Koopvaardersplantsoen 83, 1034KE, Amsterdam, The Netherlands.
J Invasive Cardiol. 2021 May;33(5):E387-E392. doi: 10.25270/jic/20.00085. Epub 2021 Apr 20.
To assess whether combining venoarterial extracorporeal membrane oxygenation (VA-ECMO) with intra-aortic balloon pump (IABP) improves outcomes in ST-segment elevation myocardial infarction (STEMI) over VA-ECMO alone.
VA-ECMO is an upcoming technique in the treatment of cardiogenic shock (CS); however, it increases afterload. IABP + VA-ECMO has been suggested to reduce afterload and increase survival.
A multicenter in-hospital registry was maintained on all patients undergoing VA-ECMO or VA-ECMO + IABP treatment for CS in STEMI.
Between 2015 and 2018, a total of 18 patients with STEMI underwent VA-ECMO ± IABP treatment for CS. The majority (n = 14; 78%) were male and median age was 59 years (interquartile range, 47-75 years). VA-ECMO + IABP was performed in 7 patients (39%) and VA-ECMO alone was performed in 11 patients (61%). The VA-ECMO + IABP group had more complex coronary anatomy and a higher number of patients with left main (LM) disease, LM + 3-vessel disease, or 3-vessel disease (VA-ECMO + IABP 86% vs VA-ECMO alone 18%; P=.03). The Survival After Veno-Arterial Extracorporeal Membrane Oxygenation (SAVE) score did not differ between the groups (VA-ECMO alone -5.9 ± 2.4 vs VA-ECMO + IABP -6.1 ± 2.6; P=.88). The SYNTAX score was higher in the VA-ECMO + IABP group (32 ± 13 vs 22 ± 14 in the VA-ECMO alone group). In the total group, a SAVE score of -6 had a predicted survival of 25%-35%. Survival in the VA-ECMO + IABP group was 100% (7/7) and survival in the VA-ECMO group was 55% (6/11); P=.04. Good neurological outcome was achieved in more patients in the VA-ECMO + IABP group (VA-ECMO alone 45% vs VA-ECMO + IABP 100%; P=.04).
In STEMI complicated by CS, VA-ECMO + IABP leads to a lower observed mortality and higher observed good neurological outcome.
评估在 ST 段抬高型心肌梗死（STEMI）患者中，与单纯使用静脉-动脉体外膜肺氧合（VA-ECMO）相比，联合使用主动脉内球囊反搏（IABP）是否能改善治疗效果。
VA-ECMO 是治疗心源性休克（CS）的一种新兴技术，但它会增加后负荷。有研究表明，IABP+VA-ECMO 可降低后负荷并提高生存率。
在 2015 年至 2018 年间，对所有在 STEMI 中因 CS 接受 VA-ECMO 或 VA-ECMO+IABP 治疗的患者进行了一项多中心院内登记。
共有 18 例 STEMI 患者接受了 VA-ECMO+IABP 或 VA-ECMO 治疗 CS。大多数患者为男性（n=14，78%），中位年龄为 59 岁（四分位距，47-75 岁）。7 例（39%）患者接受了 VA-ECMO+IABP 治疗，11 例（61%）患者仅接受了 VA-ECMO 治疗。VA-ECMO+IABP 组的冠状动脉解剖结构更复杂，左主干（LM）病变、LM+3 支血管病变或 3 支血管病变患者更多（VA-ECMO+IABP 组 86%，VA-ECMO 组 18%；P=0.03）。两组的生存后静脉-动脉体外膜肺氧合（SAVE）评分无差异（VA-ECMO 组-5.9±2.4 分，VA-ECMO+IABP 组-6.1±2.6 分；P=0.88）。VA-ECMO+IABP 组的 SYNTAX 评分更高（32±13 分 vs VA-ECMO 组 22±14 分）。在整个研究组中，SAVE 评分-6 预测的生存率为 25%-35%。VA-ECMO+IABP 组的生存率为 100%（7/7），VA-ECMO 组的生存率为 55%（6/11）；P=0.04。VA-ECMO+IABP 组有更多患者获得良好的神经功能结局（VA-ECMO 组 45%，VA-ECMO+IABP 组 100%；P=0.04）。
在 STEMI 合并 CS 的患者中，VA-ECMO+IABP 可降低死亡率，提高良好的神经功能结局。
