• Chi-Cheng Huang, Jung-Cheng Hsu, Yen-Wen Wu, Shin-Rong Ke, Jih-Hsin Huang, Kuan-Ming Chiu, and Pen-Chih Liao.
• Division of Cardiology, Cardiovascular Medical Center, Far-Eastern Memorial Hospital, New Taipei City, Taiwan.
• Int. J. Cardiol. 2018 Oct 15; 269: 45-50.

BackgroundThe mortality of patients with ST-segment elevation myocardial infarction (STEMI) and refractory cardiogenic shock (RCS) is high. Extracorporeal membrane oxygenation (ECMO) before percutaneous coronary intervention (PCI) has shown some favorable results, but this may delay door-to-balloon (D2B) time. Whether the benefit surpasses the risk of longer D2B time remains controversial.MethodsFrom January 2005 to December 2014, there were 46 patients with STEMI RCS who received ECMO and PCI. Comparison was made between patients whose ECMO were setup before (n = 12) and after (n = 34) the coronary angiography.ResultsThere were no significant differences on the baseline characteristics. The ECMO before PCI group had significantly better six-month survival (58.3% vs. 14.7%, p = 0.006), and the benefit persisted to the end of two-year follow-up (41.7% vs. 11.8%, p = 0.045). The rates of neurological, vascular, or bleeding complications were not different between the groups. ECMO before PCI was associated with a nonsignificant increase of median D2B time (30 min) and decrease of patients achieving D2B time < 90 min (9.1% vs. 32.0%). After adjusting for GRACE score, gender, D2B time, complete revascularization, ECMO before PCI and shock index < 0.8 before PCI were significantly associated with six-month survival.ConclusionsIn STEMI RCS patients, ECMO before PCI improves both short- and long-term outcomes, even if it nonsignificantly increases the D2B time. Our data suggests that ECMO before PCI is a reasonable and safe strategy in this particularly-ill population.Copyright © 2018 Elsevier B.V. All rights reserved.

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