V-A ECMO-assisted primary percutaneous coronary intervention for STEMI without access to Impella: a single-center cohort study

Primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) may be complicated by imminent hemodynamic collapse. In the absence of access to microaxial pumps (e. g., Impella), veno-arterial extracorporeal membrane oxygenation (V-A ECMO) may represent the only full-support “protected PCI” option. The aim of the study was to evaluate the effectiveness and safety of planned V-A ECMO support during pPCI in high-risk STEMI patients in a setting without access to microaxial pumps. Materials and methods. We performed a prospective single-center cohort study at the State Institution “Heart Institute of the Ministry of Health of Ukraine” (Kyiv) which included selected adult patients with STEMI who underwent planned femoro-femoral V-A ECMO before the initiation of pPCI (surgical access). The study assessed angiographic success (final TIMI 3 flow), survival to discharge, neurological status at discharge assessed using the Cerebral Performance Category (CPC) scale, and in-hospital complications (BARC type 3 bleeding, limb ischemia/vascular surgery, acute kidney injury (AKI) and renal replacement therapy (RRT). Results. The study included 21 patients (median age 69 years [64; 75], 61.9 % male). Coronary disease complexity was high (SYNTAX score 29 [26; 32]); the culprit vessel was most commonly the left main coronary artery or left anterior descending artery (each 33 %). Median door-to-balloon time was 128 [109; 151] min. Final TIMI 3 flow was achieved in 85.7 % (18/21). Survival to discharge was 61.9 % (13/21) and in-hospital mortality was 38.1 % (8/21). Among the 13 surviving patients, 11 (84.6 %) had favorable neurological outcomes at discharge (CPC 1–2). Major bleeding (BARC 3) occurred in 23.8 % (5/21), limb ischemia in 9.5 % (2/21), and the need for vascular surgery in 9.5 % (2/21). AKI developed in 42.9 % (9/21) and RRT was required in 14.0 % (3/21). Median V-A ECMO duration was 72 [48; 96] h. Conclusions. In the absence of Impella, planned V-A ECMO-assisted pPCI in selected high-risk STEMI patients was associated with a high rate of coronary blood flow restoration, favorable neurological outcomes among survivors, and a complication profile typical for full mechanical circulatory support.