Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan.
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Japan.
J Cardiol. 2022 Feb;79(2):170-178. doi: 10.1016/j.jjcc.2021.10.003. Epub 2021 Oct 27.
Among various mechanical support devices, veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is the last resort for acute myocardial infarction (AMI) patients complicated with refractory cardiogenic shock or cardiac arrest. The purpose of this study was to investigate the V-A ECMO-related complications in AMI patients who underwent percutaneous coronary intervention (PCI), and to find the association between complications and in-hospital death in that population.
We retrospectively included 101 AMI patients who received V-A ECMO and underwent PCI to the culprit lesion, and divided them into the survivor group (n=43) and the in-hospital death group (n=58). We compared the clinical characteristics and outcomes including complications between the 2 groups, and performed multivariate logistic regression analysis to find factors associated with in-hospital death and major bleeding.
The incidence of major bleeding including V-A ECMO site bleeding and intracranial hemorrhage was higher in the in-hospital death group (34.5%) than in the survivor group (7%) (p=0.001). Multivariate logistic regression analysis revealed that final thrombolysis in myocardial infarction (TIMI) flow grade ≤2 (OR 4.453, 95% CI1.427-13.894, p=0.010) and major bleeding (OR 4.986, 95% CI1.277-19.466, p=0.021) were significantly associated with in-hospital death. Out-of-hospital cardiac arrest (OHCA) was significantly associated with major bleeding (OR 3.881, 95% CI 1.358-11.089, p=0.011).
In AMI patients who received V-A ECMO and underwent PCI, final TIMI flow grade ≤2 and major bleeding were associated with in-hospital death. OHCA was closely associated with major bleeding.
在各种机械支持装置中，静脉-动脉体外膜肺氧合（V-A ECMO）是急性心肌梗死（AMI）合并难治性心源性休克或心脏骤停患者的最后手段。本研究旨在探讨接受经皮冠状动脉介入治疗（PCI）的 AMI 患者中 V-A ECMO 相关并发症，并寻找该人群中并发症与院内死亡之间的关联。
我们回顾性纳入 101 例接受 V-A ECMO 并对罪犯病变进行 PCI 的 AMI 患者，并将其分为存活组（n=43）和院内死亡组（n=58）。我们比较了两组之间的临床特征和结局，包括并发症，并进行多变量逻辑回归分析以发现与院内死亡和大出血相关的因素。
院内死亡组（34.5%）的大出血发生率（包括 V-A ECMO 部位出血和颅内出血）明显高于存活组（7%）（p=0.001）。多变量逻辑回归分析显示，最终心肌梗死溶栓治疗（TIMI）血流分级≤2（OR 4.453，95%CI1.427-13.894，p=0.010）和大出血（OR 4.986，95%CI1.277-19.466，p=0.021）与院内死亡显著相关。院外心脏骤停（OHCA）与大出血显著相关（OR 3.881，95%CI 1.358-11.089，p=0.011）。
在接受 V-A ECMO 和 PCI 的 AMI 患者中，最终 TIMI 血流分级≤2 和大出血与院内死亡相关。OHCA 与大出血密切相关。
