Outcome of Prolonged Cardiac Arrest Under Extracorporeal Cardiopulmonary Resuscitation Due to Acute Myocardial Infarction: Complete vs Culprit Revascularization

Background: Immediate revascularization of infarct-related vessel (culprit strategy) is effective in patients with acute myocardial infarction (AMI) with cardiogenic shock. However, for AMI patients complicated with prolonged cardiac arrest under extracorporeal membrane oxygenation resuscitation (ECPR), whether culprit revascularization (IR) or complete revascularization (CR) is associated with better clinical outcome is not known. Methods: Patients with AMI complicated with prolonged cardiac arrest under ECMO support between 2006 and 2016 were included and were grouped by the status of revascularization completeness in three coronary territories into IR and CR groups. The primary endpoint is favorable neurological outcomes at hospital discharge. The second endpoint is the probability of a composite of major adverse cardiac and cerebral events (MACCE) at 1-year follow-up. Results: A total of 90 patients (32 IR and 58 CR) were included. Favorable neurological outcomes at hospital discharge were 21.9% and 37.9% in IR and CR patients, respectively (P = 0.121.) Multivariate logistic regression analysis did not reveal CR a significant risk factor (odds ratio: 1.82, 95% confidence interval [CI]: 0.70–4.77, P = 0.221). One-year freedom from MACCE probabilities were 24.6% and 42.4% in IR and CR patients, respectively (P = 0.051.) Cox regression analysis revealed that CR, in addition to age, low-flow duration, and initial shockable rhythm, was a risk factor (hazard ratio: 0.53, 95% CI: 0.31–0.91, P = 0.020). Conclusion: For patients with AMI under ECPR, culprit strategy had similar result to that of CR strategy in one-year outcome.