Real-world outcomes of venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients related to acute myocardial infarction: a single-center experience

Abstract Background The benefit of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) patients is still on controversy and the previous results regarding clinical outcome according to etiology are conflicting. Objectives This study aimed to report real-world clinical outcome of VA-ECMO treatment for CS patients according to the presence of acute myocardial infarction (AMI). Methods Patients treated with peripheral VA-ECMO from 2008 to 2023 at a single tertiary cardiovascular center were included in this study. Included patients were classified into two groups based on the etiology of CS (AMI-CS and non-AMI-CS groups). In-hospital mortality was compared using logistic regression models and prognostic predictors were identified. Results Of the total 667 patients, 264 (39.6%) were classified as AMI-CS. The rate of cardiac arrest before VA-ECMO initiation was higher in the AMI-CS group than in the non-AMI-CS group (69.7% vs. 55.8%; P<0.001). The patients in the AMI-CS group were older (66 years vs. 61 years; P<0.001), more likely to be male (82.6% vs. 57.3%; P<0.001), and had a lower left ventricular (LV) ejection fraction (20% vs. 25%; P<0.001), compared with those in the non-AMI-CS group. Among 24-hour survivors, the AMI-CS group had a lower rate of in-hospital mortality (49.2% vs. 60.5%; odds ratio, 0.50; 95% confidence interval, 0.29–0.84; P=0.01) as compared to the non-AMI-CS group. Independent predictors for favorable clinical outcomes after VA-ECMO included younger age, shorter cardiac arrest duration, absence of severe LV dysfunction, higher hemoglobin levels, absence of renal replacement therapy, and lower lactate levels. Conclusions In this single-center experience, AMI-CS was associated with a lower in-hospital mortality compared with non-AMI-CS after VA-ECMO treatment.