| Objective: Objective To observe the related complications and influencing factors of extracorporeal membrane oxygenation(ECMO)combined with percutaneous coronary intervention(PCI)in the treatment of high-risk patients with coronary heart disease.Methods: a total of 42 patients with high-risk coronary heart disease who were treated with ECMO assisted PCI were divided into two groups according to the occurrence of postoperative complications: the complication group and the non complication group.The clinical data of the patients were analyzed,including baseline data,coronary artery lesions and related indicators.The difference test was used to compare the differences between the two groups,and univariate and multivariate logistic regression were used to analyze the risk factors of complications in patients with ECMO assisted PCI;the critical value and predictive value of independent risk factors of complications in patients with ECMO assisted PCI were obtained by using the receiver operating curve(ROC).Results: the age of 42 patients with high-risk coronary heart disease assisted by ECMO was 40 years The patients were 43-84(63.10 ± 11.24)years old;all patients were successfully implanted(2.95 ± 1.10)stents;the time of ECMO was(8.48 ± 19.19)hours;6 patients died in hospital(14.3%);14 patients(33.3%)had complications,6 patients(14.3%)had acute renal damage,3 patients(7.1%)had secondary thrombocytopenia and anemia,2 patients(4.8%)had severe pulmonary infection,2 patients(4.8%)had lower limb ischemic events,and 1 patient(2.3%)had surgical incision infection The average length of stay was(13.72 ± 7.88)days.The results showed that smoking history,syntax score,the number of stent implantation,ECMO time,preoperative creatine kinase,preoperative creatine kinase isoenzyme,preoperative troponin T,preoperative partial prothrombin time,preoperative C-reactive protein,preoperative creatinine and preoperative lactate were statistically different between the two groups(P<0.05).After adjusting for other factors,multivariate logistic regression analysis showed that ECMO time(OR=9.89,95%CI:1.07-91.68,P <0.05),troponin T(OR=2.38,95%CI:1.01-5.60,P <0.05),preoperative lactate(OR=26.06,95%CI:1.13-602.67,P< 0.05)were independent risk factors for complications of ECMO combined with PCI in highrisk patients with coronary heart disease.ROC curve analysis showed that the AUC of ECMO auxiliary time was 0.892(95% confidence interval 0.793-0.99),the critical value was 2.75 hours(sensitivity 85.7%,specificity 75.0%,Youden index 0.607),the AUC of troponin T was 0.908(95% confidence interval 0.818-0.998),the critical value was 0.688ng/l(sensitivity 92.9%,specificity 82.1%,Youden index 0.750),and the AUC of preoperative lactate was 0.874(95% confidence interval 0.998)The confidence interval(CI)was0.761-0.987,and the cut-off value was 1.850 mmol / L(sensitivity 85.7%,specificity 82.1%,Youden index0.679).These results suggested that ECMO combined with PCI had a good predictive value for the occurrence of postoperative complications in patients with high-risk coronary heart disease.Conclusion: ECMO combined with PCI provides an effective treatment for high-risk patients with coronary heart disease,but we still need to be alert to the occurrence of complications.EMCO time,preoperative troponin T and lactate levels may be risk factors for complications,and have a certain predictive value. |
