Long-Term Outcomes of Patients Undergoing Extracorporeal Membrane Oxygenator-Assisted High-Risk Percutaneous Coronary...

Data regarding the long-term outcomes of patients undergoing venoarterial extracorporeal membrane oxygenator (VA-ECMO) assisted high-risk percutaneous coronary intervention (PCI) and the impact of the operator experience is limited.

We aimed to investigate the long-term outcomes of patients undergoing VA-ECMO-assisted PCI and the effect of the operator experience.

The study was a retrospective cohort study that consecutively enrolled patients who were declined by the Heart Team for coronary artery bypass grafting (CABG) due to high surgical risk and treated with VA-ECMO-assisted PCI from November 1, 2016, to March 1, 2024, in Xijing Hospital, China. The primary endpoint was all-cause death at 1 year.

A total of 220 patients were included. The mean age ± SD was 65.6 ± 11.4 years and the median LVEF% (IQR) was 36.0 (30.0-40.0). The mean ± SD of the SYNTAX score was 34.7 ± 6.9. The median (IQR) follow-up was 1.9 (1.3-4.9) years, and the vital status of all patients was available at 1 year. The all-cause death occurred in 56 (25.5%) of patients at 1 year. Utilizing the restricted cubic spline, the threshold to categorize an experienced operator was performing > 10 cases of VA-ECMO-assisted PCI. Compared to the ≤ 10 cases group, the > 10 cases group was associated with a 44% decrease in risk of all-cause death (19.8% vs. 31.5%, HR adjusted: 0.56, 95% CI: 0.33-0.97, p = 0.039).

VA-ECMO-assisted PCI appeared to be a feasible option for patients unsuitable for CABG. Performing > 10 cases could be a threshold to categorize an experienced operator.

ClinicalTrials.gov identifier: NCT06713876.