Muramatsu Takashi, Inohara Taku, Kohsaka Shun, Yamaji Kyohei, Ishii Hideki, Shinke Toshiro, Toriya Takuo, Yoshiki Yu, Ozaki Yukio, Ando Hirohiko, Amano Tetsuya, Nakamura Masato, Ikari Yuji
Department of Cardiology, Cardiovascular Center, Fujita Health University Hospital, Toyoake, Japan.
Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
Eur Heart J Open. 2022 Jun 27;2(4):oeac041. doi: 10.1093/ehjopen/oeac041. eCollection 2022 Jul.
We examined in-hospital outcomes of patients that required mechanical circulatory support (MCS), such as intra-aortic balloon pumping (IABP), Impella®, or veno-arterial extracorporeal membrane oxygenation (VA-ECMO), for elective percutaneous coronary interventions (PCIs).
The J-PCI is a prospective Japanese nationwide multicentre registry sponsored by the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) and designed to collect clinical variables and in-hospital outcome data on consecutive patients undergoing PCI. Of the 253 228 patients registered between January 2018 and December 2018, 1627 patients (0.6%) undergoing elective PCI under MCS at 551 sites were analyzed. The mean age of the patients was 74 years, and 25.2% of the patients were females. Multivessel disease and left main disease were observed in 59.0% and 19.7% of the patients, respectively. Majority of patients were treated with IABP alone (86.2%), followed by IABP plus VA-ECMO (6.0%) and Impella alone (3.9%). In-hospital mortality was reported in 134 patients (8.2%). Cardiac death was more common than non-cardiac death (6.8% vs. 1.5%). About 34.6% of the patients receiving VA-ECMO died during hospitalization, whereas 7.2% and 5.3% of patients receiving Impella and IABP died, respectively ( < 0.01). The proportion of patients with VA-ECMO or Impella who had major bleeding requiring blood transfusion was higher than that of patients with IABP (14.1% vs. 13.0% vs. 2.8%).
In the setting of elective PCI, in-hospital mortality of patients requiring MCS was considerably high. VA-ECMO or Impella was associated with a higher risk of major bleeding than IABP.
我们研究了因择期经皮冠状动脉介入治疗（PCI）而需要机械循环支持（MCS）的患者的院内结局，如主动脉内球囊反搏（IABP）、Impella®或静脉-动脉体外膜肺氧合（VA-ECMO）。
J-PCI是一项由日本心血管介入与治疗协会（CVIT）发起的前瞻性日本全国多中心注册研究，旨在收集接受PCI的连续患者的临床变量和院内结局数据。在2018年1月至2018年12月期间登记的253228例患者中，分析了在551个地点接受MCS下择期PCI的1627例患者（0.6%）。患者的平均年龄为74岁，25.2%为女性。分别有59.0%和19.7% 的患者观察到多支血管病变和左主干病变。大多数患者仅接受IABP治疗（86.2%），其次是IABP加VA-ECMO（6.0%）和单独使用Impella（3.9%）。134例患者（8.2%）报告了院内死亡。心源性死亡比非心源性死亡更常见（6.8% 对1.5%）。接受VA-ECMO的患者中约34.6% 在住院期间死亡，而接受Impella和IABP的患者分别有7.2% 和5.3% 死亡（<0.01）。需要输血的大出血患者中，接受VA-ECMO或Impella的患者比例高于接受IABP的患者（14.1% 对13.0% 对2.8%）。
在择期PCI的情况下，需要MCS的患者院内死亡率相当高。与IABP相比，VA-ECMO或Impella发生大出血的风险更高。
