Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2026 Apr;38(4):325-330. doi: 10.3760/cma.j.cn121430-20250804-00421.
ABSTRACT
OBJECTIVE: To analyze the baseline data and clinical characteristics of patients with complex high-risk and indicated patients (CHIP) undergoing percutaneous coronary intervention (PCI) assisted by percutaneous femoral venous-arterial extracorporeal membrane oxygenation (VA-ECMO), and to explore the main risk factors for in-hospital death.
METHODS: A multicenter retrospective cohort study was conducted. Eighty-eight CHIP patients who underwent PCI assisted by ECMO in Hunan Provincial People's Hospital and The First Affiliated Hospital of Zhengzhou University were enrolled. Based on clinical outcomes during hospitalization, patients were categorized into a survival group and a death group. The clinical baseline data, laboratory examination results, coronary artery scores, characteristics of coronary artery lesions, duration of extracorporeal membrane oxygenation (ECMO) assistance, major complications, and in-hospital recurrence of major adverse cardiovascular events (MACE) were compared between the two groups. Multivariate Cox proportional hazards regression analysis were employed to screen independent risk factors for in-hospital death.
RESULTS: A total of 88 patients were ultimately included in the analysis. Among them, 59 (67%) survived and 29 (33%) died during hospitalization. Coronary angiography revealed that 84 patients (95%) had multi-vessel disease, 83 (94%) had lesions in the left anterior descending artery, and 39 (44%) had left main coronary artery lesions. Thirty-two patients (36%) received combined intra-aortic balloon pump (IABP) therapy, and 7 patients (8%) underwent continuous renal replacement therapy (CRRT). The incidence of bleeding, lower limb, and neurological complications were 32% (28/88), 30% (26/88), and 16% (14/88), respectively. The in-hospital recurrence of MACE after PCI was 19% (17/88). Compared with the survival group, the death group had a higher proportion of patients with a history of cerebrovascular accident, a higher serum creatinine (SCr), a higher fasting blood glucose [proportion with cerebrovascular accident history: 24% (7/29) vs. 7% (4/59), SCr (μmol/L): 97 (85, 197) vs. 80 (64, 105), fasting blood glucose (mmol/L): 12.9 (7.9, 16.6) vs. 8.4 (6.8, 11.0), all P<0.05], and a lower proportion of patients receiving ECMO assistance before PCI [28% (8/29) vs. 68% (40/59), P<0.05]. There was no significant difference in demographic characteristics, baseline data, characteristics of coronary artery lesions, or ECMO related complications between the two groups. Multivariate Cox proportional hazards regression analysis showed that elevated fasting blood glucose on admission was an independent risk factor for in-hospital death in CHIP patients undergoing PCI assisted by ECMO [odds ratio (OR)=1.134, 95% confidence interval (95%CI) was 1.022-1.259, P=0.018], while ECMO assistance before PCI was a protective factor (OR=0.119, 95%CI was 0.036-0.395, P<0.001).
CONCLUSIONS: A high in-hospital mortality was found among CHIP patients undergoing PCI assisted by VA-ECMO. Elevated fasting blood glucose on admission is an independent risk factor for in-hospital death, while timely initiation of ECMO assistance before PCI is a strong protective factor.
PMID:42200241 | DOI:10.3760/cma.j.cn121430-20250804-00421