Publié dans EuroIntervention 2018 Feb

Auteurs : Overtchouk P, Pascal J, Lebreton G, Hulot JS, Luyt CE, Combes A, Kerneis M, Silvain J, Barthelemy O, Leprince P, Brechot N, Montalescot G, Collet JP

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Background and aim :

To identify independent correlates of survival in patients undergoing PCI for refractory cardiogenic shock due to myocardial infarction (RCS-MI) with need for extracorporeal life support (ECLS).

Methods :

This observational single-tertiary-centre study enrolled 106 consecutive patients (52.7±10.4 years) with ECLS placed before or after the PCI.

Results :

Half of the patients had triple vessel disease and PCI was attempted whenever possible (74.5%). The 30-day mortality rate was 63.2%. Left main culprit vessel disease (19% of patients) (Adj. HR [95%CI]: 2.31 [1.27-4.18], p=0.006) and Sepsis-Related Organ Failure Assessment≥13 (Adj. HR 2.17 [1.25- 3.75], p=0.005) were independently associated with 30-day mortality. The use of intra-aortic balloon pump (IABP) combined with ECLS was an independent protective factor (Adj. HR 0.48 [0.28-0.80], p=0.006). Neither complete (p=0.66) nor successful (p=0.69) myocardial revascularization were associated with 30-day survival.

Conclusion :

RCS in MI patients often reveals a severe multivessel coronary artery disease with no impact of early percutaneous coronary revascularization on clinical outcome. The survival advantage of IABP when combined with ECLS further suggests that achieving an early effective haemodynamic support should be the major goal in this young patient population.