ABSTRACT
Objectives:To investigate the clinical efficacy and influencing factors on clinical outcome of extracorporeal membrane oxygenation (ECMO) combined with percutaneous coronary intervention (PCI) on cardiac arrest patients due to acute myocardial infarction (AMI). Methods:The clinical data of 37 cardiac arrest patients post AMI who underwent ECMO combined with emergency PCI therapy strategies from January 2015 to January 2017 were retrospectively analyzed. The clinical data of the surviving group (17 cases) and the death group (20 cases) were compared and the outcome determinants were investigated. Results:37 patients were successfully treated with emergency PCI with the help of ECMO device, and the successful operation rate was 100%. The survival rate was 45.9% (17/37). There was no significant difference in gender, age and past history between the two groups (P＞0.05). The proportion of right coronary artery lesion was the highest (47.06%) in the surviving group, and the percent of the left anterior descending coronary artery lesion was the highest (60.00%) in the death group. Most patients (70.0%) in the death group had three vessel lesions and around half the patients (52.9%) in the surviving group had two-vessel lesions. The time of traditional cardiopulmonary resuscitation ([31.4±5.2] min vs [54.6±25.7] min),the time from cardiac arrest to ECMO ([47.5±19.5] h vs [93.6±60.5] h) were significantly shorter, while CCU time (16.0[8.7, 32.6] d vs 4.0[2.0, 12.0] d) was significantly longer in the surviving group compared to the death group (all P＜0.05). The mean arterial pressure at 24 h and 48 h after ECMO was significantly higher in the surviving group (89.6±21.9,87.9±19.4) than in the death group (71.8±19.3, 63.7±18.6) (both P＜0.05). Unconditional logistic regression analysis showed that left anterior descending artery lesion (OR=0.723, 95%CI:0.516~0.947), higher lesion vessel number (OR=1.638,95%CI:1.107~1.729), longer cardiopulmonary resuscitation time (OR=0.712, 95%CI:0.436~0.973), prolonged cardiac arrest to ECMO placement time (OR=0.698, 95%CI:0.411~0.859) were risk factors of death, and the higher MBP at 48 h after ECMO (OR=0.672,95%CI:0.326~0.693) was the protective factor of death (all P＜0.05) in this patient cohort. Conclusions:ECMO combined with emergency PCI is safe and can improve the success rate of rescue in patients with cardiac arrest after acute myocardial infarction.
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate the safety and efficacy of drug-eluting stent (DES) implantation in selective patients with left main coronary artery disease.</p><p><b>METHOD</b>From October 2002 to November 2007, 44 consecutive patients underwent percutaneous coronary interventions (PCI) on left main coronary artery lesions, including 5 patients with concurrent left ventricular dysfunction (ejection fraction<40%), 2 with chronic respiratory dysfunction and 5 with chronic renal failure. The findings in coronary angiography, procedural success rate, severe complications and the follow-up results of the patients were analyzed.</p><p><b>RESULTS</b>The immediate procedural success rate was 100% in these patients without any severe complications. No non-fatal acute myocardial infarction or emergency coronary artery bypass grafting (CABG) was performed and death occurred in none of the cases during hospitalization. In the follow-up period for 14.2-/+9.3 (6-65) months after PCI, no subacute or late thromboses were found. One patient died from heart failure 4 months after PCI, and 6 patients (13.6%) experienced recurrent angina. Thirty-seven patients (84.1%) were free of any major cardiovascular events (MACE) after the procedure. A repeat coronary angiography was performed in 35 patients (79.5%) within 6 months after PCI, and 3 (8.6%) of them were confirmed to have restenosis, including 1 patient with distal bifurcation restenosis who were subsequently treated with CABG and two patients with side-branch ostium restenosis managed with cutting balloon dilation.</p><p><b>CONCLUSIONS</b>Implantation of drug-eluting stents is safe and effective for management of left main coronary artery disease with good immediate and long-term outcomes.</p>