Revascularization Strategy on Outcome for Acute Myocardial Infarct under Extracorporeal Cardiopulmonary Resuscitation

Abstract

Abstract Background: Revascularization of infarct-related vessel is effective in patients with acute myocardial infarction (AMI) with cardiogenic shock. However, for AMI patients complicated with cardiac arrest under extracorporeal cardiopulmonary resuscitation (ECPR), whether complete revascularization (CR) is associated with better clinical outcome is unknown. Methods: Patients with AMI under ECPR in 10 years were included. The study patients were grouped by the status of revascularization completeness in the coronary territories into incomplete revascularization (IR) and CR groups. The primary endpoint is favorable neurological outcomes at hospital survival. The second endpoint is the probability of a composite of major adverse cardiac and cerebral events (MACCE), defined as cardiac death, myocardial infarction, revascularization, or stroke at 1-year follow-up. Results: A total of 90 patients (32 IR and 58 CR) were included. Favorable neurological outcomes at hospital discharge were 21.9% and 37.9% in IR and CR patients, respectively (p = 0.12) Multivariate logistic regression analysis did not reveal CR a significant risk factor (odds ratio: 1.82, 95% confidence interval [CI]: 0.70–4.77, P = 0.221). One-year freedom from MACCE probabilities were 24.6% and 42.4% in IR and CR patients, respectively (P = 0.051.) Cox regression analysis revealed that CR, in addition to age, low-flow duration, and initial shockable rhythm, was a risk factor (hazard ratio: 0.53, 95% CI: 0.31–0.91, P = 0.020). Conclusion: For patients with AMI under ECPR, CR strategy seems not to is associated with better one-year outcomes than IR. Culprit lesion approach may be reasonable in the critical status.