Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Japan.
J Cardiol. 2022 Feb;79(2):163-169. doi: 10.1016/j.jjcc.2021.08.011. Epub 2021 Sep 10.
Mechanical circulatory support (MCS) is essential to maintain the hemodynamics in selected patients with cardiogenic shock (CS). However, little is known about predictors and clinical impact of device-related complications on clinical outcomes in patients with MCS.
We retrospectively reviewed consecutive 477 patients who received veno-arterial extracorporeal membrane oxygenation (VA-ECMO), Impella (Abiomed, Danvers, MA, USA), and intra-aortic balloon pump (IABP) from January 2012 to May 2020. After excluding patients with only VA-ECMO and patients with MCS for procedural support, 403 patients were included in this study. Predictors and clinical outcomes of device-related complications were analyzed. Furthermore, complication rates were compared between Impella and IABP groups in patients with and without VA-ECMO.
Hemolysis, major bleeding defined by Bleeding Academic Research Consortium type 3 or 5 bleeding, thromboembolic events, and ischemic stroke were observed in 42 (10.4%), 150 (37.2%), 52 (12.9%), and 30 patients (7.4%), respectively. Patients with major bleeding had a higher in-hospital mortality than those without major bleeding (31.2% vs. 56.0%, p<0.001), whereas hemolysis (47.6% vs. 52.4%, p=0.32), thromboembolic events (38.5% vs. 40.7%, p=0.76), and ischemic stroke (48.5% vs. 39.7%, p=0.33) did not increase the in-hospital mortality. In multivariate analysis, both Impella and VA-ECMO were independent predictors of major bleeding and thromboembolic events. However, in-hospital mortality was similar between the Impella and IABP groups irrespective of the VA-ECMO insertion.
Among several important complications in CS patients with MCS, major bleeding events most strongly affected the mortality. Implanted MCS type was associated with the device-related complications.
机械循环支持（MCS）对于维持心源性休克（CS）患者的血液动力学至关重要。然而，对于 MCS 患者中与器械相关的并发症对临床结果的预测因素和临床影响知之甚少。
我们回顾性分析了 2012 年 1 月至 2020 年 5 月期间连续接受静脉-动脉体外膜肺氧合（VA-ECMO）、Impella（Abiomed，马萨诸塞州丹弗斯）和主动脉内球囊泵（IABP）治疗的 477 例患者。排除仅接受 VA-ECMO 治疗和因程序支持而接受 MCS 治疗的患者后，共有 403 例患者纳入本研究。分析了与器械相关的并发症的预测因素和临床结果。此外，比较了有和无 VA-ECMO 的患者中 Impella 和 IABP 组的并发症发生率。
42 例（10.4%）、150 例（37.2%）、52 例（12.9%）和 30 例（7.4%）患者分别发生溶血、BARC 3 或 5 级大出血、血栓栓塞事件和缺血性卒中。大出血患者的院内死亡率高于无大出血患者（31.2% vs. 56.0%，p<0.001），而溶血（47.6% vs. 52.4%，p=0.32）、血栓栓塞事件（38.5% vs. 40.7%，p=0.76）和缺血性卒中（48.5% vs. 39.7%，p=0.33）并未增加院内死亡率。多变量分析显示，Impella 和 VA-ECMO 均是大出血和血栓栓塞事件的独立预测因素。然而，无论是否插入 VA-ECMO，Impella 组和 IABP 组的院内死亡率相似。
在心源性休克患者中，与机械循环支持相关的几种重要并发症中，大出血事件对死亡率影响最大。植入的 MCS 类型与器械相关并发症有关。
