title: Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock.
abstract: OBJECTIVE
  The aim of this study was to evaluate the impact of extracorporeal membrane oxygenation (ECMO) assistance on the clinical outcome of patients with acute myocardial infarction (AMI) that is complicated by profound cardiogenic shock (CS) who received primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  We collected patients from January 2004 through December 2006 (stage 1); 25 patients who presented with AMI and received primary PCI and had profound CS were enrolled in the study. Intraaortic balloon counterpulsation (IABP) was the only modality for extracorporeal support in our hospital. From January 2007 through December 2009 (stage 2), 33 patients who presented with AMI and received primary PCI and had profound CS were enrolled; for this stage; both intra-aortic balloon counter-pulsation and ECMO support were available in our facility.
  
  
  RESULTS
  A Kaplan-Meier survival analysis displayed significantly improved survival for patients in stage 2 (P = .001; 1-year survival in stage 1 vs 2; 24% vs 63.64%). Patients presenting with either STEMI (ST segment elevation myocardial infarction) or NSTEMI (Non-ST segment elevation myocardial infarction) benefited from ECMO-assisted PCI (P < .05). In stage 1, patients with refractory ventricular tachycardia/ventricular fibrillation had a very low survival rate; however, in stage 2, the survival rate of patients with and without refractory ventricular tachycardia/ventricular fibrillation was similar (P = .316).
  
  
  CONCLUSIONS
  Extracorporeal membrane oxygenation-assisted PCI for patients with AMI that is complicated by profound CS may improve the 30-day and 1-year survival rates.
authors.affiliation: Division of Cardiovascular surgery, Department of Surgery, Taipei Medical University Hospital, Taipei 11031, Taiwan.
authors.forename: Nai-Wen
authors.initials: NW
authors.lastname: Tsao
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Shih
authors.forename: Jong-Shiuan
authors.initials: JS
authors.lastname: Yeh
authors.forename: Yung-Ta
authors.initials: YT
authors.lastname: Kao
authors.forename: Ming-Hsiung
authors.initials: MH
authors.lastname: Hsieh
authors.forename: Keng-Liang
authors.initials: KL
authors.lastname: Ou
authors.forename: Jaw-Wen
authors.initials: JW
authors.lastname: Chen
authors.forename: Kou-Gi
authors.initials: KG
authors.lastname: Shyu
authors.forename: Zen-Chung
authors.initials: ZC
authors.lastname: Weng
authors.forename: Nen-Chung
authors.initials: NC
authors.lastname: Chang
authors.forename: Feng-Yen
authors.initials: FY
authors.lastname: Lin
authors.forename: Chun-Yao
authors.initials: CY
authors.lastname: Huang
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D015908:Counterpulsation; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality*; D013997:Time Factors