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Updated: Jun 11, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
ECMO versus IABP for patients with STEMI complicated by cardiogenic shock undergoing primary PCI: a Chinese National
Hongbo Yang1, Lingfeng Luo2, Yanan Song1
1Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China; National Clinical Research Center for Interventional Medicine, Shanghai, China.
Insights
Extracorporeal membrane oxygenation (ECMO) improved survival in ST-segment elevation myocardial infarction (STEMI) patients with cardiogenic shock compared to intra-aortic balloon pump (IABP). ECMO significantly reduced in-hospital mortality in this high-risk group.
Area of Science:
- Cardiology
- Interventional Cardiology
- Critical Care Medicine
Background:
- ST-segment elevation myocardial infarction (STEMI) with cardiogenic shock is a critical condition.
- Primary percutaneous coronary intervention (PCI) is the standard treatment.
- Mechanical circulatory support is often required for hemodynamic stabilization.
Purpose of the Study:
- To compare the effectiveness of ECMO versus IABP in patients with STEMI and cardiogenic shock undergoing primary PCI.
- To evaluate the association between ECMO or IABP use and in-hospital mortality.
- To identify potential survival benefits of ECMO in this patient population.
Main Methods:
- Retrospective analysis of 9635 patients from the Chinese Cardiovascular Association database (2019-2021).
- Inclusion criteria: STEMI with cardiogenic shock treated with primary PCI and ECMO/IABP support.
- Propensity score-matched analysis (1:2 ratio) to compare in-hospital mortality between ECMO and IABP groups.
Main Results:
- ECMO was used in 2028 patients, and IABP in 7607 patients.
- ECMO group showed significantly lower in-hospital mortality (7.2% vs. 15.1%, p < 0.001).
- In the propensity-matched cohort, ECMO was associated with a 34% reduced risk of in-hospital mortality (7.7% vs. 11.7%; OR = 0.66; p < 0.001).
Conclusions:
- ECMO demonstrates superior outcomes compared to IABP in patients with STEMI complicated by cardiogenic shock undergoing primary PCI.
- ECMO is associated with improved in-hospital survival in this high-risk patient cohort.
- These findings support the consideration of ECMO for selected patients requiring mechanical circulatory support during STEMI with cardiogenic shock.
Objective:
This study investigated the association between the utilization of extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pump (IABP) and in-hospital mortality among patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock undergoing primary percutaneous coronary intervention (PCI).
Methods:
Data encompassing 9635 cases of STEMI complicated by cardiogenic shock and treated with primary PCI using ECMO/IABP support were retrieved from the Chinese Cardiovascular Association database (2019-2021). We conducted an analysis to assess the in-hospital survival disparities among percutaneous mechanical circulatory device recipients and explore the potential advantages of ECMO through multivariable logistic regression analysis within a propensity score-matched (1:2) cohort population.
Results:
ECMO was administered to 2028 patients, whereas IABP was used in 7607 patients. Patients supported by ECMO showed a lower in-hospital mortality than those supported by IABP (7.2% versus 15.1%, p < 0.001). Within the propensity-matched (case: control = 1:2) cohort, we noted a 34% reduced risk of in-hospital mortality among patients supported by ECMO compared with those supported by IABP (7.7% versus 11.7%; odds ratio = 0.66; 95% CI, 0.53-0.80; p < 0.001) independent of age, sex, systolic blood pressure, obesity, smoke, hypertension, diabetes, dyslipidemia, family history of coronary artery disease, coronary artery disease, stroke, atrial filiation, peripheral artery disease, chronic kidney disease, vascular lesion sites, 3A-grade hospital, and regional distributions in China.
Conclusion:
Among patients undergoing primary PCI for STEMI complicated by cardiogenic shock, ECMO was associated with better in-hospital survival than IABP.
