Predictors of Survival and Ventricular Recovery Following Acute Myocardial Infarction Requiring Extracorporeal Membrane Oxygenation Therapy.
Justin A FriedJan M GriffinAmirali MasoumiKevin D ClerkinLucas J WiterVeli K TopkaraDimitri KarmpaliotisLeRoy RabbaniPaolo C ColomboMelana YuzefpolskayaHiroo TakayamaYoshifumi NakaAjay J KirtaneDaniel BrodieGabriel SayerNir UrielKoji TakedaA Reshad GaranPublished in: ASAIO journal (American Society for Artificial Internal Organs : 1992) (2022)
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) following acute myocardial infarction with cardiogenic shock (AMI-CS) is increasing, but the ability to predict favorable outcomes with support remains limited. We retrospectively reviewed all patients with AMI-CS supported with VA-ECMO between December 2008 and June 2018. One hundred twenty-six patients received VA-ECMO for AMI-CS during the study period; of these, 39 (31.0%) experienced ventricular recovery and were discharged while 87 (69.0%) did not recover, with 71 (56.3%) dying in the hospital and 16 (12.7%) surviving to discharge with either left ventricular assist device or heart transplant. TIMI 3 flow in culprit artery (OR, 4.01; 95% CI, 1.25-12.77; p = 0.02), serum lactate (OR, 0.89; 95% CI, 0.80-0.99; p = 0.04), and prompt revascularization (OR, 3.39; 95% CI, 1.18-9.81; p = 0.02) were independent predictors of ventricular recovery. Four variables emerged as independent predictors of in-hospital mortality and were used to create the AMI-ECMO Risk Score: age >70 years, creatinine >1.5 mg/dL, serum lactate > 4.0 mmol/L, and lack of TIMI 3 flow in culprit artery. In patients supported with VA-ECMO for AMI-CS, prompt, successful revascularization, and lower serum lactate were associated with ventricular recovery while younger age, lower serum lactate, and creatinine, and successful revascularization were associated with survival to discharge. The AMI-ECMO risk score is a simple tool that can help risk stratify patients with AMI-CS being considered for VA-ECMO support.
Keyphrases
- extracorporeal membrane oxygenation
- acute myocardial infarction
- acute respiratory distress syndrome
- percutaneous coronary intervention
- left ventricular
- respiratory failure
- end stage renal disease
- heart failure
- newly diagnosed
- acute coronary syndrome
- ejection fraction
- coronary artery disease
- coronary artery bypass grafting
- chronic kidney disease
- mechanical ventilation
- peritoneal dialysis
- healthcare
- prognostic factors
- palliative care
- skeletal muscle
- insulin resistance
- mesenchymal stem cells
- weight loss
- cell therapy
- adverse drug