Efficacy of Mechanical Circulatory Support Used Before Versus After Primary Percutaneous Coronary Intervention in Patients with Cardiogenic Shock From ST-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis

Rio‐Pertuz, Gaspar Del; Benjanuwattra, Juthipong; Juarez, Michel; Mekraksakit, Poemlarp; Argueta-Sosa, Erwin; Ansari, Mohammad

doi:10.1016/j.carrev.2022.05.002

Cited by 18 publications

(4 citation statements)

References 43 publications

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“…Current guidelines advised that MCS could be used in patients who occur acute myocardial infarction or CS (9,13). Recently, a meta-analysis showed the mortality is lower in patients with ST-elevation myocardial infarction complicated by cardiogenic shock who undergoing primary percutaneous coronary intervention with ECMO (15). Although, some studies explored the effective and safety of ECMO support in elective HR-PCI patients, there results still are limited.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation in patients with acute coronary syndrome during high-risk percutaneous coronary intervention

Ma,

Chen,

Wang

et al. 2023

Preprint

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Background Percutaneous coronary intervention (PCI) is feasible for patients with complex coronary atherosclerotic disease in coronary revascularization. The safety and feasibility of Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for circulatory support in patients with acute coronary syndrome (ACS) during high-risk PCI remain unclear. Methods This single-center retrospective study, 41patients with ACS who received VA-ECMO circulation-assisted PCI in Lanzhou University Second Hospital from January 2021 to September 2022. General clinical data, laboratory test results, short-term outcome, postoperative complications of patients were collected and analyzed. Results Among 41 patients, only one failed stent implantation due to severe tortuous vessels, 41 patients were successfully performed PCI, and no patient died during the operation. 12 (29.3%) patients occurred postoperative complications included postoperative infection occurred in 6 (14.6%) patients, 8 (19.1%) patients occurred hypotension, 1 (2.4%) patient occurred cerebral hemorrhage, 1 (2.4%) patient happened death due to retroperitoneal hematoma combined with acute heart failure and cardiogenic shock. Conclusion The PCI in complex and high-risk coronary artery lesions with VA-ECMO support is safe and feasible. The benefits of PCI with ECMO need to confirm by larger sample and randomized controlled trials in the future.

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Section: Discussionmentioning

confidence: 99%

Extracorporeal membrane oxygenation in patients with acute coronary syndrome during high-risk percutaneous coronary intervention

Ma,

Chen,

Wang

et al. 2023

Preprint

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“…In patients with acute myocardial infarction complicated with CS, VA-ECMO combined with IABP instrumental circulatory support significantly reduced mortality compared with VA-ECMO alone ( 19 ). For STEMI patients with CS undergoing PCI, the application of Impella or VA-ECMO before PCI significantly reduced mortality, whereas the use of IABP before and after PPCI had no effect on mortality ( 20 ). Huang et al reported that for STEMI patients, ECMO implantation prior to PCI improved survival at six months and improved short- and long-term outcomes ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Concomitant percutaneous coronary intervention and transcatheter aortic valve replacement for aortic stenosis complicated with acute STEMI: a case report and literature review

Xu,

Hu,

2023

Front. Cardiovasc. Med.

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Aortic stenosis (AS) complicated with acute ST-segment elevation myocardial infarction (STEMI) is a life-threatening emergency with high mortality. A 75-year-old male patient attended the emergency department of Wuhan Asia Heart Hospital in December 2021 with chest pain for 2 days and exacerbation for 1 h. The electrocardiogram (ECG) indicated atrial fibrillation with rapid ventricular response and ST-segment depression. Echocardiography showed severe AS and mild/moderate aortic insufficiency. The patient refused coronary angiography and further invasive procedures and then requested discharge, but he had recurrent chest pain on the third day. The ECG showed an extensive anterior wall STEMI. During preoperative preparation, he suffered from cardiogenic shock (CS). Concomitant percutaneous coronary intervention (PCI) and transcatheter aortic valve replacement (TAVR) was performed, but he died of CS and multiple organ failure 4 days after surgery. Patients with AS and STEMI might be susceptible to CS during perioperative period of concomitant PCI and TAVR, which requires proactive prevention.

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“…A meta-analysis on the basis of observational data involving 1352 patients undergoing MCS for AMI-CS (IABP: n=956, Impella: n=203, VA-ECMO: n=193) found that VA-ECMO initiation before PCI was associated with a significantly lower risk of mortality. 54 By contrast, aggressive CS management with early VA-ECMO initiation did not translate to improved outcomes in the individual-patient data meta-analysis of AMI-CS trials. 39 These findings call for a more vigorous assessment of timing in clinical trial protocols also in studies involving CS pathogeneses other than myocardial infarction, keeping in mind the association of VA-ECMO and increased LV afterload.…”

Section: Va-ecmo In Postcardiotomy Csmentioning

confidence: 96%

Scrutinizing the Role of Venoarterial Extracorporeal Membrane Oxygenation: Has Clinical Practice Outpaced the Evidence?

Lüsebrink,

Binzenhöfer,

Hering

et al. 2024

Circulation

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The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for temporary mechanical circulatory support in various clinical scenarios has been increasing consistently, despite the lack of sufficient evidence regarding its benefit and safety from adequately powered randomized controlled trials. Although the ARREST trial (Advanced Reperfusion Strategies for Patients with Out-of-Hospital Cardiac Arrest and Refractory Ventricular Fibrillation) and a secondary analysis of the PRAGUE OHCA trial (Prague Out-of-Hospital Cardiac Arrest) provided some evidence in favor of VA-ECMO in the setting of out-of-hospital cardiac arrest, the INCEPTION trial (Early Initiation of Extracorporeal Life Support in Refractory Out-of-Hospital Cardiac Arrest) has not found a relevant improvement of short-term mortality with extracorporeal cardiopulmonary resuscitation. In addition, the results of the recently published ECLS-SHOCK trial (Extracorporeal Life Support in Cardiogenic Shock) and ECMO-CS trial (Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock) discourage the routine use of VA-ECMO in patients with infarct-related cardiogenic shock. Ongoing clinical trials (ANCHOR [Assessment of ECMO in Acute Myocardial Infarction Cardiogenic Shock, NCT04184635], REVERSE [Impella CP With VA ECMO for Cardiogenic Shock, NCT03431467], UNLOAD ECMO [Left Ventricular Unloading to Improve Outcome in Cardiogenic Shock Patients on VA-ECMO, NCT05577195], PIONEER [Hemodynamic Support With ECMO and IABP in Elective Complex High-risk PCI, NCT04045873]) may clarify the usefulness of VA-ECMO in specific patient subpopulations and the efficacy of combined mechanical circulatory support strategies. Pending further data to refine patient selection and management recommendations for VA-ECMO, it remains uncertain whether the present usage of this device improves outcomes.

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Efficacy of Mechanical Circulatory Support Used Before Versus After Primary Percutaneous Coronary Intervention in Patients with Cardiogenic Shock From ST-Elevation Myocardial Infarction: A Systematic Review and Meta-Analysis

Cited by 18 publications

References 43 publications

Extracorporeal membrane oxygenation in patients with acute coronary syndrome during high-risk percutaneous coronary intervention

Extracorporeal membrane oxygenation in patients with acute coronary syndrome during high-risk percutaneous coronary intervention

Concomitant percutaneous coronary intervention and transcatheter aortic valve replacement for aortic stenosis complicated with acute STEMI: a case report and literature review

Scrutinizing the Role of Venoarterial Extracorporeal Membrane Oxygenation: Has Clinical Practice Outpaced the Evidence?

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