Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands.
Rijnstate Hospital, Arnhem, Netherlands.
J Interv Cardiol. 2022 Sep 16;2022:7245384. doi: 10.1155/2022/7245384. eCollection 2022.
If surgical revascularization is not feasible, high-risk PCI is a viable option for patients with complex coronary artery disease. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides hemodynamic support in patients with a high risk for periprocedural cardiogenic shock.
This study aims to provide data about short-term outcomes of elective high-risk PCI with ECMO support.
A retrospective single-center registry was performed on patients with high-risk PCI receiving VA-ECMO support. The short-term outcome was defined as the incidence of major adverse cardiac events (MACE) during the hospital stay and within 60 days after discharge.
Between January 2020 and December 2021, 14 patients underwent high-risk PCI with ECMO support. The mean age was 66.5 (±2.5) and the majority was male (71.4%) with a mean left ventricular ejection fraction of 33% (±3.0). Complexity indexes were high (STS-PROM risk score: 2.9 (IQR 1.5-5.8), SYNTAX score I: 35.5 (±2.0), SYNTAX score II (PCI): 49.8 (±3.2)). Femoral artery ECMO cannulation was performed in 13 patients (92.9%) requiring additional antegrade femoral artery cannula in one patient because of periprocedural limb ischemia. The mean duration of the ECMO run was 151 (±32) minutes. One patient required prolonged ECMO support and was weaned after 2 days. Successful revascularization was achieved in 13 patients (92.8%). Procedural success was achieved in 12 patients (85.7%) due to one unsuccessful revascularization and one procedural death. MACE during hospital stay occurred in 4 patients (28.6%) and within 60 days after discharge in 2 patients (16.7%).
High-risk PCI with hemodynamic support using VA-ECMO is a feasible treatment option, if surgical revascularization is considered very high risk. Larger and prospective studies are awaited to confirm the benefits of ECMO support in elective high-risk PCI comparing ECMO with other mechanical circulatory support devices, including coaxial left cardiac support devices and IABP. . This trial is registered with NCT05387902.
如果手术血运重建不可行，高危 PCI 是复杂冠状动脉疾病患者的可行选择。静脉动脉体外膜肺氧合（VA-ECMO）为围手术期心源性休克高危患者提供血流动力学支持。
本研究旨在提供接受 ECMO 支持的择期高危 PCI 的短期结果数据。
对接受 VA-ECMO 支持的高危 PCI 患者进行回顾性单中心登记。短期结果定义为住院期间和出院后 60 天内主要不良心脏事件（MACE）的发生率。
2020 年 1 月至 2021 年 12 月，14 例行 ECMO 支持的高危 PCI 患者。平均年龄为 66.5（±2.5）岁，大多数为男性（71.4%），平均左心室射血分数为 33%（±3.0）。复杂性指数较高（STS-PROM 风险评分：2.9（IQR 1.5-5.8），SYNTAX 评分 I：35.5（±2.0），SYNTAX 评分 II（PCI）：49.8（±3.2））。13 例患者（92.9%）行股动脉 ECMO 插管，1 例患者因围手术期肢体缺血需额外行顺行股动脉插管。ECMO 运行的平均时间为 151（±32）分钟。1 例患者需要长时间 ECMO 支持，2 天后脱机。13 例患者（92.8%）成功再血管化。12 例患者（85.7%）达到手术成功，因 1 例再血管化失败和 1 例手术死亡。住院期间发生 MACE 的患者有 4 例（28.6%），出院后 60 天内发生 MACE 的患者有 2 例（16.7%）。
如果手术血运重建被认为风险非常高，使用 VA-ECMO 进行血流动力学支持的高危 PCI 是一种可行的治疗选择。更大规模和前瞻性研究有待证实 ECMO 支持在择期高危 PCI 中的益处，与其他机械循环支持设备（包括同轴左心支持设备和 IABP）相比，比较 ECMO 与其他机械循环支持设备。该试验在 NCT05387902 注册。
