Prophylactic VA-ECMO During Complex High-Risk PCI

Prophylactic VA-ECMO During Complex High-Risk PCI

Background: Evidence on prophylactic venoarterial extracorporeal membrane oxygenation (VA-ECMO) during elective percutaneous coronary intervention (PCI) in patients with complex high-risk coronary artery lesions is limited. Objectives: The authors aimed to assess the safety and effectiveness of prop...

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Main Authors: Chenliang Pan, MD, Youqi Zhu, MD, Jing Zhao, MD, Bo Zhang, MD, Sixiong Hu, MD, Cunrui Zhao, MD, Xiaoxue Meng, MD, Xinghu Zhou, MD, Yurun Su, MD, Erkun Xing, MM, Peng Lei, MD, Nan Bai, MD, Juan Ma, MD, Xiaojuan Wang, MD, Andong Lu, MD, Ming Bai, MD
Format: Article
Language:English
Published: Elsevier 2025-09-01
Series:JACC: Advances
Subjects:
complex high-risk coronary artery intervention
efficacy
major adverse cardiovascular and cerebrovascular events
safety
venoarterial extracorporeal membrane oxygenation
Online Access:http://www.sciencedirect.com/science/article/pii/S2772963X25005204
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Summary:Background: Evidence on prophylactic venoarterial extracorporeal membrane oxygenation (VA-ECMO) during elective percutaneous coronary intervention (PCI) in patients with complex high-risk coronary artery lesions is limited. Objectives: The authors aimed to assess the safety and effectiveness of prophylactic VA-ECMO during PCI. Methods: This single-center, randomized trial enrolled 70 patients with complex high-risk coronary lesions (Synergy Between PCI with Taxus and Cardiac Surgery [SYNTAX] score ≥33) who declined coronary artery bypass grafting. Patients were divided into those who had prophylactic VA-ECMO (n = 34) prior to PCI and controls who did not have prophylactic VA-ECMO (n = 36). Elective PCI was performed, and complications were recorded. Life-threatening complications included: 1) cardiac arrest unresponsive to cardiopulmonary resuscitation; 2) cardiogenic shock; 3) acute left heart failure unresponsive to therapy; and 4) refractory malignant arrhythmias. SYNTAX scores pre- and post-PCI were calculated. The primary endpoints were the rate of complications during PCI and SYNTAX score reduction post-PCI. Results: Between June 2021 and August 2023, 70 patients (women: 14.3%) underwent PCI. SYNTAX scores in the VA-ECMO and control group were similar (37.8 [34.5-44.0] vs 35.8 [33.2-40.8], P = 0.11). Life-threatening complications were lower in the VA-ECMO group compared to controls (0% vs 19.4%; P = 0.01). Emergency VA-ECMO was required in 19.4% of the control group. The VA-ECMO group showed greater absolute reduction in SYNTAX scores (27.2 [24.5-35.0] vs 22.5 [11.5-32.8], P = 0.04). Conclusions: In this single-center study of patients undergoing elective PCI of complex high-risk coronary lesions, prophylactic VA-ECMO was associated with lower rates of life-threatening complications and larger reduction in SYNTAX scores. Larger studies are needed to further define optimal management strategies in high-risk complex PCI.
ISSN:2772-963X

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