Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France; Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France.
Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France; Health Data Department, Lyon University Hospital, Lyon, France.
Int J Cardiol. 2023 Jun 1;380:14-19. doi: 10.1016/j.ijcard.2023.03.037. Epub 2023 Mar 20.
We aimed to analyze the impact of timing of implantation (strategy-outcome relationship) and volume of procedures (volume-outcome relationship) on survival of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for cardiogenic shock complicating acute myocardial infarction (AMI).
We conducted an observational retrospective study through two propensity score-based analyses using a nationwide database between January 2013 and December 2019. We classified patients into early implantation (VA ECMO on the day of primary percutaneous coronary intervention [PCI]) and delayed implantation (VA ECMO beyond the day of PCI) groups. We classified patients into low- or high-volume groups based on the median hospital volume.
During the study period 649 VA ECMO were implanted across 20 French hospitals. Mean age was 57.1 ± 10.4 years, 80% were male. Overall, 90-day mortality was 64.3%. Patients in the early implantation group (n = 479, 73.8%) did not show a statistical difference in 90-day mortality than in the delayed group (n = 170, 26.2%) (HR: 1.18; 95% CI 0.94-1.48; p = 0.153). The mean number of VA ECMO implanted during the study period by low-volume centers was 21.3 ± 5.4 as compared to 43.6 ± 11.8 in high-volume centers. There was no significant difference in 90-day mortality between high-volume and low-volume centers (HR: 1.00; 95% CI: 0.82-1.23; p = 0.995).
In this real-world nationwide study, we did not find a significant association between early VA ECMO implantation as well as high-volume centers and lower mortality in AMI-related refractory cardiogenic shock.
本研究旨在分析急性心肌梗死（AMI）并发心原性休克患者行静脉-动脉体外膜肺氧合（VA ECMO）的时机（策略-结局关系）和手术量（量效关系）对患者生存的影响。
本研究通过两次基于倾向评分的分析，使用全国性数据库，对 2013 年 1 月至 2019 年 12 月期间的患者进行了观察性回顾性研究。我们将患者分为早期植入（初次经皮冠状动脉介入治疗[PCI]当日行 VA ECMO）和延迟植入（PCI 后行 VA ECMO）两组。根据医院的中位手术量，我们将患者分为低手术量或高手术量组。
研究期间，共有 20 家法国医院共植入 649 例 VA ECMO。患者平均年龄为 57.1±10.4 岁，80%为男性。总的来说，90 天死亡率为 64.3%。与延迟组（n=170，26.2%）相比，早期植入组（n=479，73.8%）患者 90 天死亡率无统计学差异（HR：1.18；95%CI：0.94-1.48；p=0.153）。低手术量中心在研究期间植入的 VA ECMO 平均数量为 21.3±5.4 例，而高手术量中心则为 43.6±11.8 例。高手术量中心和低手术量中心之间 90 天死亡率无显著差异（HR：1.00；95%CI：0.82-1.23；p=0.995）。
在这项真实世界的全国性研究中，我们没有发现早期 VA ECMO 植入和高手术量中心与 AMI 相关难治性心原性休克死亡率降低之间存在显著关联。
