Comparison Of The Effects Of Different MCS On Short Term Survival Rate In Patients With AMI Complicated With Profound CS

Objective:To investigate the efficacy and safety of extracorporeal membrane oxygenation(ECMO)in patients with acute myocardial infarction(AMI)complicated with profound cardiogenic shock(CS).Background:Although mechanical circulatory support(MCS)devices have been widely used in the reperfusion therapy of patients with AMI complicated with profound CS,but the mortality has not decreased significantly.As a rescue measure in the treatment of profound CS,the evaluation of the effectiveness of ECMO is still lack of data support.Methods:This study is a single center,retrospective study,including all patients who were hospitalized in the First Hospital of Lanzhou University from July 1,2015to October 31,2021 because of AMI and profound CS.A total of 81 patients with AMI complicated with severe CS were enrolled in this study.According to the different use of MCS device,patients were divided into the ECMO(n=37)and intra-aortic balloon pumping(IABP)groups(n=44).The primary outcome of our study was 30-day mortality.Secondary outcomes included perioperative mortality,90-day mortality,average length of stay of surviving patients,renal failure requiring continuous renal replacement treatment(CRRT),life-threatening bleeding,moderate bleeding,ischemic complications,and bacteremia.Results:The average age of the total population included in the study was 62years old,and 79%of them were male.Patients with an average lactate level of7.05mmol/L,72%had multivessel disease(multi vessel disease,MVD).Compared with IABP group,the 30-day mortality rate of the ECMO group(68.2%vs.43.2%,χ~2=8.423,P=0.004)and perioperative mortality(20.0%vs.0.00%,χ~2=5.877,P=0.015)were significantly lower than those of the ECMO group,but ECMO prolonged the average hospital stay of surviving patients(15.5 vs.11.5,p=0.027).In a subgroup analysis of patients with MVD who received ECMO support,we found that the30-day mortality rate of patients who underwent immediate multi vessel PCI was significantly lower than those underwent primary PCI of the culprit vessel only(21.4%vs.61.5%,χ~2=4.402,P=0.036).Conclusion:ECMO can significantly reduce 30-day mortality of AMI patients with profound CS without increasing the risk of severe complications.In addition,with the assistance of ECMO,the 30-day mortality rate of patients with MVD and immediate multivessel PCI was significantly lower than that of patients who only treated culprit vessels.