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Published on: August 16, 2021
Percutaneous cardiopulmonary support after acute myocardial infarction at the left main trunk
Takashi Yamauchi1, Takafumi Masai, Koji Takeda
1Department of Cardiovascular Surgery, Sakurabashi Watanabe Hospital, Osaka, Japan.
Insights
Percutaneous cardiopulmonary support (PCPS) for left main trunk (LMT) acute myocardial infarction (AMI) shows unsatisfactory outcomes. Early left ventricular assist system (LVAS) insertion may improve survival for these critical patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- Percutaneous cardiopulmonary support (PCPS) is increasingly used for cardiogenic shock post-acute myocardial infarction (AMI).
- Clinical outcomes for AMI involving the left main trunk (LMT) treated with PCPS are not well-established.
- This study investigates the efficacy and outcomes of PCPS in LMT-AMI patients.
Purpose of the Study:
- To evaluate the clinical outcomes of patients with acute myocardial infarction (AMI) involving the left main trunk (LMT) who required percutaneous cardiopulmonary support (PCPS).
- To identify factors influencing survival and recovery in this high-risk patient group.
Main Methods:
- Retrospective analysis of 16 LMT-AMI patients requiring emergent PCPS between January 2000 and September 2007.
- All patients underwent percutaneous coronary intervention (PCI) and intra-aortic balloon pumping (IABP).
- Data collected included patient demographics, creatine kinase levels, time to revascularization, and support durations.
Main Results:
- 10 out of 16 patients (62.5%) were successfully weaned from PCPS; 6 (37.5%) were discharged.
- Three patients received left ventricular assist system (LVAS) implantation, with two surviving over 100 days.
- Mortality was high (8 patients) due to low output syndrome or brain death; delayed revascularization (>4 hours) and prolonged PCPS (>3 days) correlated with poor cardiac recovery.
Conclusions:
- Clinical outcomes for LMT-AMI patients requiring PCPS are currently unsatisfactory.
- Timely left ventricular assist system (LVAS) implantation before complications arise may be a necessary strategy to improve survival.
- Further research into optimal timing and patient selection for advanced support is warranted.
Background:
Percutaneous cardiopulmonary support (PCPS) has recently become an accepted modality for the treatment of cardiogenic shock after acute myocardial infarction (AMI). However, the clinical outcomes of patients with AMI at the left main trunk (LMT) undergoing PCPS remain unclear.
Patients And Methods:
From January 2000 to September 2007, we experienced 16 cases of AMI at the LMT requiring emergent PCPS. The average age ranged from 56 to 74 (mean 68.8), and 13 were male. All cases underwent percutaneous coronary intervention (PCI). The maximum creatine kinase leakage ranged from 6,069 to 22,580 IU/l (mean; 12,880 IU/l). The time to revascularization ranged from 30 min to 1,138 min (mean 229 min). An intra-aortic balloon pumping (IABP) was inserted in all patients.
Results:
Among our 16 patients, 10 (62.5%) could be successfully weaned off PCPS, and 6 (37.5%) could be weaned off both PCPS and IABP and discharged. Three patients underwent left ventricular assist system (LVAS) implantation. Two of them, without preoperative severe systemic complications, survived more than 100 days after implantation, whereas the third died perioperatively because of a systemic complication from the preoperative period. Eight patients died of low output syndrome or brain death. Cardiac function did not recover in patients in whom the time to revascularization was more than 4 hours and PCPS support duration more than 3 days.
Conclusions:
The clinical outcomes of patients with LMT disease requiring PCPS is not satisfactory. In order to improve clinical outcomes of these patients, a strategy involving a timely insertion of LVAS before the onset of complications might be necessary.
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