title: Short-term and long-term prognostic outcomes of patients with ST-segment elevation myocardial infarction complicated by profound cardiogenic shock undergoing early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention.
abstract: BACKGROUND
  This study investigated the 30-day and long-term prognostic outcomes in patients with ST-segment elevation myocardial infarction (STEMI) complicated with profound cardiogenic shock (CS) undergoing early routine extracorporeal membrane oxygenator (ECMO)-assisted primary percutaneous coronary intervention (PCI).
  
  
  METHODS
  Between December 2005 and December 2014, 65 consecutive STEMI patients with profound CS underwent routine ECMO-supported primary PCI.
  
  
  RESULTS
  The incidences of acute pulmonary edema, respiratory failure with requirement of mechanical ventilatory support upon presentation, and 30-day mortality rate were 100%, 95.4%, and 43.1%, respectively. The duration of hospitalization, mean long-term follow-up, and survival rate were 32.1±53.1 (days), 733.6±986.7 (days), and 32.3%, respectively. The mean APACHE score (32.6±8.3 vs. 28.5±7.5), peak serum creatinine level (4.3±2.4 vs. 1.7±1.2mg/dL), incidences of failed ECMO weaning (57.1% vs. 0%), successful ECMO weaning but in-hospital death (40.0% vs. 0%) were significantly lower in 30-day survivors than those in non-survivors (all p<0.05), whereas final thrombolysis in myocardial infarction (TIMI)-3 flow [53.6% vs. 91.9%] showed an opposite pattern compared to that of APACHE score in the two groups (p<0.02). Multivariate analysis demonstrated that unsuccessful reperfusion, failed ECMO weaning, and peak creatinine level were independent predictors of 30-day mortality (all p<0.01).
  
  
  CONCLUSIONS
  Early ECMO-supported primary PCI in STEMI patients with profound CS was feasible as a life-saving strategy with acceptable 30-day and long-term prognostic outcomes.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Sheng-Ying
authors.initials: SY
authors.lastname: Chung
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Meng-Shen
authors.initials: MS
authors.lastname: Tong
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Jiunn-Jye
authors.initials: JJ
authors.lastname: Sheu
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Fan-Yen
authors.initials: FY
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Pei-Hsun
authors.initials: PH
authors.lastname: Sung
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chien-Jen
authors.initials: CJ
authors.lastname: Chen
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Cheng-Hsu
authors.initials: CH
authors.lastname: Yang
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chiung-Jen
authors.initials: CJ
authors.lastname: Wu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Nursing, Asia University, Taichung, Taiwan. Electronic address: han.gung@msa.hinet.net.
authors.forename: Hon-Kan
authors.initials: HK
authors.lastname: Yip
mesh_terms: D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors
keywords: Extracorporeal membrane oxygenator support; Primary percutaneous coronary intervention; Profound cardiogenic shock; Short-term and long-term outcomes