Abstract 4332: Clinical Outcome of Patients With Acute Coronary Syndrome Receiving Percutaneous Extracorporeal Life Support
Background: Extracorporeal life support (ECLS) can maintain vital organ perfusion in patients with critical hemodynamic conditions. Data on percutaneous ECLS for patients suffering from cardiac arrest or cardiogenic shock due to acute coronary syndrome (ACS) has been scarce. We retrospectively evaluated the clinical features and in-hospital outcome of these patients.
Methods: Between January 2000 and May 2009, a total of 186 patients received percutaneous ECLS in our hospital. Of these, 119 patients (76 male, 72.5±11.1 years) who presented with ACS were evaluated. A multiple logistic regression analysis was performed to identify independent variables associated with in-hospital mortality.
Results: One hundred fifteen patients presented with acute myocardial infarction including 36 cardiopulmonary arrest on arrival and 4 patients presented with unstable angina pectoris. Clinical status prior to introduction of ECLS were cardiopulmonary arrest in 79 (30 ventricular fibrillation/pulseless ventricular tachycardia and 49 asystole/pulseless electrical activity) and cardiogenic shock in 40. The mean time from circulatory collapse to ECLS initiation was 22.5±15.6 minutes. One hundred twelve patients (94.1%) underwent emergency revascularization (107 PCI and 5 CABG). Success reperfusion was achieved in 109 patients (97.3%). During ECLS support, 112 patients (94.1%) received intra-aortic balloon pumping and 51 (42.9%) received continuous hemodiafiltration. Forty-two patients (35.3%) underwent therapeutic mild hypothermia. Sixty-three patients (52.9%) could be weaned from ECLS. Mean duration of ECLS support was 64.2±63.6 hours. ECLS-related complication occurred in 32 patients (26.9%). Survival rate to hospital discharge was 30.3%. Multivariate analysis revealed independent predictors of in-hospital mortality were age, time from circulatory collapse to ECLS initiation, and ECLS-related complication.
Conclusion: Patients with ACS who received percutaneous ECLS had a high in-hospital mortality despite high rate of revascularization. Age, time from circulatory collapse to ECLS initiation, and ECLS-related complication were independent predictors of in-hospital mortality.