Author + information
- Mariusz Zadura,
- Frank Szigat,
- Barnaba Hejazin,
- Ronald Bittner,
- Peter Szigat,
- Claudia Bischoff and
- Wolfgang Motz
Background: Due to the high mortality rate, the therapy of patients (PTS) with an acute coronary syndrome (ACS) and cardiogenic shock (CS) remains still a challenge. Over many years we used an intra-aortic balloon pump (IABP), but with disappointing results. After the publication of the SHOCK II – trial we changed our strategy and started to use an extracorporeal circulatory life support (ECLS) instead of IABP. The aim of our study was to proof whether ECLS is superior to IABP in PTS with ACS and CS treated with PCI.
Methods: We analyzed and compared the outcome of 64 consecutive PTS with ACS and CS treated with PCI since 01/2009 till 09/2016: 28 PTS supported with IABP were analyzed retrospectively (23 M and 5 W, mean age 68y) from 2009 to 2012 (IABP-group (IABP)) and 36 PTS supported with ECLS were observed and analyzed prospectively (33 M and 3W, mean age 68y) from 2013 to 2016 (ECLS group (ECLS)). In the baseline characteristic we saw the significance of the incidence of the 3-vessel disease (3VD) (ECLS 31 PTS (86%), IABP 14 PTS (50%), p = 0,01) and of the CTO of the non-infarct-related artery (CTO-NIRA) (ECLS 24 PTS (66%), IABP 6 PTS (21%), p = 0,004). The incidence of previous MI, PCI, CABG and the serum lactate level (LAC) on admission (ECLS 6,68 vs IABP 6,23 mmol/l average) were not significant.
Results: From ECLS, 22 PTS (61%) survived the acute CS-phase and were weaned from the support system. From IABP only 7 PTS (25%) survived and were weaned and it was significant (p= 0,004). Since 2 PTS died of sepsis, 1 PTS of refractory ventricular fibrillation and 1 of multi organ failure, 18 PTS (50%) of the ECLS survived to discharge vs 7 PTS (25%) of the IABP and this result was significant (p = 0,04). Between both groups we observed 2 differences: the LAC normalization was longer in ECLS (56,44 hours (h)) vs IABP (22,16 h) and it was significant (p = 0,03); the time to weaning in survivors was also longer in ECLS (average 154 h) vs IABP (95 h) but it was not significant.
Conclusions: The use of ECLS in PTS with ACS and CS treated with PCI is superior to the use of the IABP. Our findings support the recommendation, that IABP should not be longer considered as a treatment option in this clinical setting.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Novel Developments in Acute Coronary Syndromes
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1194-150
- 2017 American College of Cardiology Foundation