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Article Abstract
Background: This study aimed to identify the determinant factors of survival in patients with acute myocardial infarction (AMI) and refractory cardiogenic shock (RCS) who underwent veno-arterial extracorporeal membrane oxygenation (ECMO).
Methods: Sixty-nine consecutive patients with AMI-related RCS were enrolled in the study. They were treated with ECMO and primary percutaneous coronary intervention (PCI). The clinical scores and coronary angiography (CAG) factors related to 100-day survival were evaluated.
Results: Thirty patients (43.5%) survived for more than 100 days. The CAG showed that 19 (27.5%) patients had left main disease (LMD). There were 17 (24.6%), 27 (39.1%), and 25 (36.3%) patients with one-vessel, two-vessel, and three-vessel disease, respectively. There were significant differences between the survivors and non-survivors in the simplified acute physiology score II (SAPSII) (65.4±17.2 . 83.1±13.0, P<0.001), sepsis-related organ failure assessment score (SOFA) (10.4±2.7 . 12.3±2.5, P=0.004), survival after veno-arterial extracorporeal membrane oxygenation score (SAVE) (-4.4±4.3 . -8.4±3.1, P<0.001), CPR time (15.8±16.6 . 30.0±29.5, P=0.048), LMD [4 (13.3%) . 15 (38.5%), P=0.029], and number of coronary artery disease (NCAD) (P<0.001). Multivariate logistic regression analysis showed that NCAD (OR 3.788, P=0.008) was one of the independent predictors of mortality. The ROC analysis showed that SAPSII (AUC 0.786, P<0.001), SOFA (AUC 0.715, P=0.002), and SAVE (AUC 0.766, P<0.001) equally predict mortality. The combined NCAD parameters more accurately predicted mortality and differences in the AUC values (d-AUC) between SAPSII plus NCAD . SAPSII (d-AUC 0.073, z=2.256, P=0.024), SOFA plus NCAD . SOFA (d-AUC 0.058, z=2.773, P=0.006), and SAVE plus NCAD . SAVE (d-AUC 0.036, z=2.332, P=0.020).
Conclusions: The SAPSII, SOFA, and SAVE scores predict the prognosis of ECMO-treated AMI patients with RCS. The CAG findings reinforce the predictive power of each score.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330300 | PMC |
| http://dx.doi.org/10.21037/jtd.2020.03.51 | DOI Listing |
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