Extracorporeal Membrane Oxygenation Support for Complex Percutaneous Coronary Interventions in Patients without Cardiogenic Shock

It has been shown that extracorporeal membrane oxygenation (ECMO) may provide cardiopulmonary support during percutaneous coronary interventions (PCI) in patients with refractory cardiogenic shock. Current guidelines consider ECMO and implantable left ventricular assist devices in selected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients. High-risk PCI remains a viable revascularization strategy for those patients who are not suitable for surgery or those refusing it. However, such a subset of patients is considered to be at an extremely high risk of PCI complications as there is a risk of hemodynamic collapse during balloon inflations or complex procedures, particularly, if coronary dissection with vessel closure or no reflow occurs. This chapter is devoted to the use of ECMO support for high-risk complex PCI in NSTE-ACS patients without cardiogenic shock based on the theoretical rationale, observational retrospective single-center studies and clinical case examples

Long-Term Outcome of High-Risk Percutaneous Coronary Interventions with Extracorporeal Membrane Oxygenation Support for Patients Without Cardiogenic Shock

Percutaneous coronary intervention (PCI) has evolved into the high-risk category in the past 2 decades. Endovascular patients are on average sicker than in the past due to increased age, complex anatomy, reduced global left ventricular systolic function and a greater frequency of surgical refusal. Extracorporeal membrane oxygenation (ECMO) can be taken into account for the management of extremely high-risk PCI without any hemodynamic instability. The rationale for the use of ECMO includes a lower risk of hemodynamic collapse which leads to low perfusion episodes minimization. In the evidence based on ECMO-assisted high-risk PCI, there are no randomized clinical trials but only observational studies and case reports. In this paper, we describe one-year long-term results of ECMO support for PCI in patients without hemodynamic disturbances

High-Sensitivity Troponin I after Cardiac Surgery and 30-Day Mortality

BACKGROUND Consensus recommendations regarding the threshold levels of cardiac troponin elevations for the definition of perioperative myocardial infarction and clinically important periprocedural myocardial injury in patients undergoing cardiac surgery range widely (from >10 times to ≥70 times the upper reference limit for the assay). Limited evidence is available to support these recommendations. METHODS We undertook an international prospective cohort study involving patients 18 years of age or older who underwent cardiac surgery. High-sensitivity cardiac troponin I measurements (upper reference limit, 26 ng per liter) were obtained 3 to 12 hours after surgery and on days 1, 2, and 3 after surgery. We performed Cox analyses using a regression spline that explored the relationship between peak troponin measurements and 30-day mortality, adjusting for scores on the European System for Cardiac Operative Risk Evaluation II (which estimates the risk of death after cardiac surgery on the basis of 18 variables, including age and sex). RESULTS Of 13,862 patients included in the study, 296 (2.1%) died within 30 days after surgery. Among patients who underwent isolated coronary-artery bypass grafting or aortic-valve replacement or repair, the threshold troponin level, measured within 1 day after surgery, that was associated with an adjusted hazard ratio of more than 1.00 for death within 30 days was 5670 ng per liter (95% confidence interval [CI], 1045 to 8260), a level 218 times the upper reference limit. Among patients who underwent other cardiac surgery, the corresponding threshold troponin level was 12,981 ng per liter (95% CI, 2673 to 16,591), a level 499 times the upper reference limit. CONCLUSIONS The levels of high-sensitivity troponin I after cardiac surgery that were associated with an increased risk of death within 30 days were substantially higher than levels currently recommended to define clinically important periprocedural myocardial injury.Instituto de Salud Carlos III6 month embargo; published 3 March 2022This item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]