Factors influencing of the clinical outcome of interventional therapy for complex high-risk indicated coronary artery disease assisted by extracorporeal membrane oxygenation / 中华急诊医学杂志

ABSTRACT

Objective:To explore the factors influencing the clinical outcome of complex high-risk indicated patients percutaneous coronary intervention (CHIP-PCI) assisted by extracorporeal membrane oxygenation (ECMO).Methods:The clinical data of patients with CHIP-PCI assisted by ECMO in the First Affiliated Hospital of Zhengzhou University from April 2018 to April 2022 were retrospectively collected and analyzed. Patients were divided into the survival and death groups according to the in-hospital survival status. The baseline characteristic, the results of coronary angiography, and the use of ECMO, blood products and drug were compared between the two groups. The 24-h rate of change of biochemical test indicators after the use of ECMO were calculated and the univariate analysis was analyzed using rank sum test. According to the univariate analysis, the variables ( P<0.05) were included in multivariate logistic regression to analyze the factors affecting the clinical outcomes of patients. Results:A total of 67 CHIP patients who completed PCI with ECMO were included. In the survival group ( n=36), the duration of ECMO treatment was 59 (41, 87) h, 9 cases received continuous renal replacement therapy, and 11 cases received IABP. In the death group ( n=31), the duration of ECMO treatment was 31 (19, 80) h, 12 cases received continuous renal replacement therapy and10 cases received IABP. The proportion of patients with chronic total occlusion lesions (CTOs) in the survival group was lower than that in the death group, the duration of ECMO of the survival group was longer than that of the death group ( P<0.05). Multivariate logistic regression analysis showed that 24-h lactate change rate ( OR=2.864, 95% CI 1.185-6.918, P=0.019), 24-h eGFR change rate ( OR=0.050, 95% CI 0.003-0.871, P=0.040), 24-h D-dimer change rate ( OR=1.497, 95% CI 1.044-2.146, P=0.028) and 24-h direct bilirubin change rate ( OR=2.617, 95% CI 1.121-6.111, P=0.026) were associated with in-hospital mortality. Conclusions:Within 24 h after CHIP-PCI assisted by ECMO, the rapid decline in lactic acid, D-dimer and direct bilirubin, and the rapid recovery of eGFR, are associated with the decreased risk of hospital mortality from CHIP.