Short-Term Outcomes of Elective High-Risk PCI with Extracorporeal Membrane Oxygenation Support: A Single-Centre Registry

Alexander M Griffioen, Stijn C H Van Den Oord, Marleen H Van Wely, Gerard C Swart, Herbert B Van Wetten, Peter W Danse, Peter Damman, Niels Van Royen, Robert Jan M Van Geuns, Alexander M Griffioen, Stijn C H Van Den Oord, Marleen H Van Wely, Gerard C Swart, Herbert B Van Wetten, Peter W Danse, Peter Damman, Niels Van Royen, Robert Jan M Van Geuns

Abstract

Background: If surgical revascularization is not feasible, high-risk PCI is a viable option for patients with complex coronary artery disease. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides hemodynamic support in patients with a high risk for periprocedural cardiogenic shock.

Objective: This study aims to provide data about short-term outcomes of elective high-risk PCI with ECMO support.

Methods: A retrospective single-center registry was performed on patients with high-risk PCI receiving VA-ECMO support. The short-term outcome was defined as the incidence of major adverse cardiac events (MACE) during the hospital stay and within 60 days after discharge.

Results: Between January 2020 and December 2021, 14 patients underwent high-risk PCI with ECMO support. The mean age was 66.5 (±2.5) and the majority was male (71.4%) with a mean left ventricular ejection fraction of 33% (±3.0). Complexity indexes were high (STS-PROM risk score: 2.9 (IQR 1.5-5.8), SYNTAX score I: 35.5 (±2.0), SYNTAX score II (PCI): 49.8 (±3.2)). Femoral artery ECMO cannulation was performed in 13 patients (92.9%) requiring additional antegrade femoral artery cannula in one patient because of periprocedural limb ischemia. The mean duration of the ECMO run was 151 (±32) minutes. One patient required prolonged ECMO support and was weaned after 2 days. Successful revascularization was achieved in 13 patients (92.8%). Procedural success was achieved in 12 patients (85.7%) due to one unsuccessful revascularization and one procedural death. MACE during hospital stay occurred in 4 patients (28.6%) and within 60 days after discharge in 2 patients (16.7%).

Conclusion: High-risk PCI with hemodynamic support using VA-ECMO is a feasible treatment option, if surgical revascularization is considered very high risk. Larger and prospective studies are awaited to confirm the benefits of ECMO support in elective high-risk PCI comparing ECMO with other mechanical circulatory support devices, including coaxial left cardiac support devices and IABP. Trial Registration. This trial is registered with NCT05387902.

Conflict of interest statement

Dr. Damman reported grants, speaker fees, consultancy fees from Philips, grants and speaker fees from Abbott, and grants from AstraZeneca. Dr. Van Royen reported grants and speaker fees from Abbott, and grants from Medtronic, Biotronik, and Philips. Dr. Van Geuns reported grants and personal fees from Boston Scientific, grants and personal fees from Abbott Vascular, grants and personal fees from Astra Zeneca, grants and personal fees from Amgen, and grants from InfraRedx. All other authors reported that there are no conflicts of interest to declare.

Copyright © 2022 Alexander M. Griffioen et al.

Figures

Figure 1
Figure 1
Flowchart of PCI procedures performed with ECMO support. CAG, coronary angiography; ECMO, extracorporeal membrane oxygenation; PCI, percutaneous coronary intervention.

References

    1. Neumann F. J., Sousa-Uva M., Ahlsson A., et al. ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal . 2019;40(2):87–165.
    1. Valgimigli M., Tebaldi M., Borghesi M., et al. Two-year outcomes after first- or second-generation drug-eluting or bare-metal stent implantation in all-comer patients undergoing percutaneous coronary intervention: a pre-specified analysis from the PRODIGY study (PROlonging Dual Antiplatelet Treatment after Grading stent-induced Intimal hyperplasia studY) JACC: Cardiovascular Interventions . 2014;7(1):20–28. doi: 10.1016/j.jcin.2013.09.008.
    1. Waldo S. W., Secemsky E. A., O’Brien C., et al. Surgical ineligibility and mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention. Circulation . 2014;130(25):2295–2301. doi: 10.1161/circulationaha.114.011541.
    1. Perera D., Stables R., Thomas M., et al. Elective intra-aortic Balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. JAMA . 2010;304(8):867–874. doi: 10.1001/jama.2010.1190.
    1. Perera D., Stables R., Thomas M., Booth J. Long-Term Mortality Data From the Balloon Pump–Assisted Coronary Intervention Study (BCIS-1) Circulation . 2013;127
    1. Henriques J. P., Remmelink M., Baan J., et al. Safety and feasibility of elective high-risk percutaneous coronary intervention procedures with left ventricular support of the Impella Recover LP 2.5. The American Journal of Cardiology . 2006;97(7):990–992. doi: 10.1016/j.amjcard.2005.10.037.
    1. Sjauw K. D., Konorza T., Erbel R., et al. Supported high-risk percutaneous coronary intervention with the Impella 2.5 device: the europella registry. Journal of the American College of Cardiology . 2009;54(25):2430–2434. doi: 10.1016/j.jacc.2009.09.018.
    1. Maini B., Naidu S. S., Mulukutla S., et al. Real-world use of the Impella 2.5 circulatory support system in complex high-risk percutaneous coronary intervention: the USpella Registry. Catheterization and Cardiovascular Interventions . 2012;80(5):717–725. doi: 10.1002/ccd.23403.
    1. Chieffo A., Ancona M. B., Burzotta F., et al. Observational multicentre registry of patients treated with IMPella mechanical circulatory support device in Italy: the IMP-IT registry. EuroIntervention . 2020;15(15):e1343–e1350. doi: 10.4244/eij-d-19-00428.
    1. Spiro J., Doshi S. N. Use of left ventricular support devices during acute coronary syndrome and percutaneous coronary intervention. Current Cardiology Reports . 2014;16(12):p. 544. doi: 10.1007/s11886-014-0544-x.
    1. Vainer J., van Ommen V., Maessen J., Geskes G., Lamerichs L., Waltenberger J. Elective high-risk percutaneous coronary interventions supported by extracorporeal life support. The American Journal of Cardiology . 2007;99(6):771–773. doi: 10.1016/j.amjcard.2006.10.034.
    1. Shaukat A., Hryniewicz-Czeneszew K., Sun B., et al. Outcomes of extracorporeal membrane oxygenation support for complex high-risk elective percutaneous coronary interventions: a single-center experience and review of the literature. Journal of Invasive Cardiology . 2018;30(12):456–460.
    1. van den Brink F. S., Meijers T. A., Hofma S. H., et al. Prophylactic veno-arterial extracorporeal membrane oxygenation in patients undergoing high-risk percutaneous coronary intervention. Netherlands Heart Journal . 2020;28(3):139–144. doi: 10.1007/s12471-019-01350-8.
    1. Tomasello S. D., Boukhris M., Ganyukov V., et al. Outcome of extracorporeal membrane oxygenation support for complex high-risk elective percutaneous coronary interventions: a single-center experience. Heart and Lung . 2015;44(4):309–313. doi: 10.1016/j.hrtlng.2015.03.005.
    1. Rihal C. S., Naidu S. S., Givertz M. M., et al. SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular Care: endorsed by the American heart association, the cardiological society of India, and sociedad latino americana de Cardiología intervencionista; affirmation of value by the Canadian association of interventional cardiology-association canadienne de Cardiologie d’intervention. Journal of the American College of Cardiology . 2015;65(19):2140–2141. doi: 10.1016/j.jacc.2015.02.043.
    1. Kappetein A. P., Head S. J., Genereux P., et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document†. European Heart Journal . 2012;33(19):2403–2418. doi: 10.1093/eurheartj/ehs255.
    1. Hajjar L. A., Teboul J.-L. Mechanical circulatory support devices for cardiogenic shock: state of the art. Critical Care . 2019;23(1):p. 76. doi: 10.1186/s13054-019-2368-y.
    1. Bougouin W., Dumas F., Lamhaut L., et al. Extracorporeal cardiopulmonary resuscitation in out-of-hospital cardiac arrest: a registry study. European Heart Journal . 2020;41(21):1961–1971. doi: 10.1093/eurheartj/ehz753.
    1. Yannopoulos D., Bartos J., Raveendran G., et al. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. The Lancet . 2020;396:1807–1816. doi: 10.1016/s0140-6736(20)32338-2.
    1. Chieffo A., Dudek D., Hassager C., et al. Joint EAPCI/ACVC expert consensus document on percutaneous ventricular assist devices. EuroIntervention . 2021;17(4):e274–e286. doi: 10.4244/eijy21m05_01.
    1. O’Neill W. W., Kleiman N. S., Moses J., et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic Balloon Pump in patients undergoing high-risk percutaneous coronary intervention. Circulation . 2012;126(14):1717–1727. doi: 10.1161/circulationaha.112.098194.
    1. Thiele H., Ohman E. M., de Waha-Thiele S., Zeymer U., Desch S. Management of cardiogenic shock complicating myocardial infarction: an update 2019. European Heart Journal . 2019;40(32):2671–2683. doi: 10.1093/eurheartj/ehz363.
    1. Russo J. J., Aleksova N., Pitcher I., et al. Left ventricular unloading during extracorporeal membrane oxygenation in patients with cardiogenic shock. Journal of the American College of Cardiology . 2019;73(6):654–662. doi: 10.1016/j.jacc.2018.10.085.

Source: PubMed

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