Qiu Wenjie, Chen Wanying, Qin Yajun, Zhou Yifang, Zhou Yuanshen
The Second Clinical College of Guangzhou University of Chinese Medicine, 510006 Guangzhou, Guangdong, China.
Department of Cardiovascular, Guangdong Provincial Hospital of Chinese Medicine, 510120 Guangzhou, Guangdong, China.
Rev Cardiovasc Med. 2025 May 26;26(5):27126. doi: 10.31083/RCM27126. eCollection 2025 May.
Complex high-risk and indicated patients (CHIPs) increase the risk of in-hospital death after percutaneous coronary intervention (PCI). Extracorporeal membrane oxygenation (ECMO) support can improve survival. However, there remains a gap in knowledge regarding how to identify and manage these high-risk patients effectively to reduce mortality. This study aimed to determine the independent high-risk factors associated with increased risk of in-hospital mortality among CHIPs after PCI with ECMO support. This research focused on providing clinicians with more accurate risk assessment tools for devising more effective treatment plans for these patients.
The EMBASE, PubMed, Cochrane Library, Web Of Science, Chinese Biomedical Database, China National Knowledge Infrastructure, China Science and Technology Journal Database, and Wanfang databases were searched from their inception to October 1, 2024, to identify observational studies examining mortality risk amongst adult CHIPs (age ≥18 years). The primary outcome was in-hospital mortality. A meta-analysis used random-effects models to obtain summary odds ratios (ORs) with 95% confidence intervals (CIs). The Cochrane risk-of-bias tool assessed the quality of evidence.
Ten studies with 306 participants were included. In pooled analyses, cardiogenic shock (CS) or cardiac arrest (CA) to ECMO (mean difference (MD) : 34.61, 95% confidence interval (CI): 26.70 to 42.52; < 0.00001), ECMO duration (MD : -19.93, 95% CI: -32.85 to -7.02; = 0.002), type of infarction-associated coronary artery-left anterior descending (LAD; OR : 3.16, 95% CI: 1.83 to 5.47; < 0.0001), body mass index (BMI; MD: 1.52, 95% CI: 1.06 to 1.97; < 0.00001), lactate levels (MD: 3.15, 95% CI: 2.37 to 3.94; < 0.00001), left ventricle ejection fraction (LVEF; MD: -4.09, 95% CI: -6.17 to -2.00; = 0.0001), mean arterial pressure (MAP; MD: -24.92, 95% CI: -32.19 to -17.65; < 0.00001), heart rate, male sex, left circumflex, and right coronary artery, were associated with in-hospital mortality.
CHIPs with longer CS or CA to ECMO, shorter ECMO duration, LAD infarction, higher BMI, elevated lactate levels, and lower LVEF and MAP have an increased risk of in-hospital death.
复杂高危及特定患者（CHIPs）会增加经皮冠状动脉介入治疗（PCI）后院内死亡风险。体外膜肺氧合（ECMO）支持可提高生存率。然而，在如何有效识别和管理这些高危患者以降低死亡率方面，仍存在知识空白。本研究旨在确定PCI联合ECMO支持后CHIPs中与院内死亡风险增加相关的独立高危因素。本研究聚焦于为临床医生提供更准确的风险评估工具，以便为这些患者制定更有效的治疗方案。
检索EMBASE、PubMed、Cochrane图书馆、科学引文索引数据库、中国生物医学数据库、中国知网、中国科技期刊数据库和万方数据库，检索时间从建库至2024年10月1日，以识别关于成人CHIPs（年龄≥18岁）死亡风险的观察性研究。主要结局为院内死亡。采用随机效应模型进行荟萃分析，以获得汇总比值比（ORs）及95%置信区间（CIs）。使用Cochrane偏倚风险工具评估证据质量。
纳入10项研究，共306名参与者。在汇总分析中，心源性休克（CS）或心脏骤停（CA）至开始使用ECMO的时间（平均差（MD）：34.61，95%置信区间（CI）：26.70至42.52；P<0.00001）、ECMO持续时间（MD：-19.93，95%CI：-32.85至-7.02；P=0.002）、梗死相关冠状动脉类型-左前降支（LAD；OR：3.16，95%CI：1.83至5.47；P<0.0001）、体重指数（BMI；MD：1.52，95%CI：1.06至1.97；P<0.00001）、乳酸水平（MD：3.15，95%CI：2.37至3.94；P<0.00001）、左心室射血分数（LVEF；MD：-4.09，95%CI：-6.17至-2.00；P=0.0001）、平均动脉压（MAP；MD：-24.92，95%CI：-32.19至-17.65；P<0.00001）、心率、男性、左旋支和右冠状动脉与院内死亡相关。
从CS或CA至开始使用ECMO时间较长、ECMO持续时间较短、LAD梗死、BMI较高、乳酸水平升高以及LVEF和MAP较低的CHIPs院内死亡风险增加。
