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Outcomes of Extracorporeal Membrane Oxygenation vs. Intra-Aortic Balloon Pump in STEMI Patients Undergoing Primary PCI: A Retrospective Comparative Analysis
Session:
SESSÃO DE POSTERS 35 - DOENÇAS CARDIOVASCULARES - CHOQUE CARDIOGÉNICO 1
Speaker:
Ana Raquel Carvalho Santos
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Raquel Carvalho Santos; Fernando Ferreira; André Grazina; Pedro Brás; Tiago Mendonça; Luis Morais; Ruben Ramos; António Fiarresga; Lidia Sousa; Inês Rodrigues; Duarte Cacela; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:12.0pt">In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), mechanical circulatory support devices, such as intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO), play a critical role in select cases. While existing studies suggest potential benefits of ECMO over IABP, detailed comparative analyses of outcomes and patient characteristics remain essential to inform clinical decisions.</span></span></span></p> <p style="text-align:justify"><br /> <span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:12.0pt">This retrospective analysis compared clinical outcomes and baseline characteristics between patients treated with IABP-only (n=104) and ECMO-only (n=24). Variables included demographics, revascularization completeness, stent use, number of vessels treated, complications, mechanical ventilation, provisional pacemaker use, and mortality outcomes. </span></span></span></p> <p style="text-align:justify"><br /> <span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:12.0pt">Patients in the ECMO-only group were younger (mean age 56.3 vs. 62.7 years, p=0.032) and more frequently presented with cardiac arrest before intervention (41.7% vs. 12.5%, p=0.003), reflecting a higher severity of illness. Complete revascularization was achieved in 65% of IABP-only patients compared to 50% of ECMO-only patients (p=0.097). Stent use was similar (97.1% vs. 95.8%, p=0.623). ECMO-treated patients had fewer vessels treated (1.83 vs. 2.31, p=0.045) with no significant differences in the number of lesions addressed. Provisional pacemaker use was more frequent in the ECMO group (37.5% vs. 19.2%, p=0.049), as was the need for invasive ventilation (58.3% vs. 36.5%, p=0.042). Thirty-day mortality was higher in ECMO-only patients (29.2% vs. 11.5%, p=0.006). However, this group also experienced more cardiac arrests and had greater overall risk, suggesting that patient selection influenced outcomes. Complications, including angiographic and clinical events, and rates of 30-day rehospitalization did not differ significantly between groups.</span></span></span></p> <p style="text-align:justify"><br /> <span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:12.0pt">Among STEMI patients undergoing PCI, ECMO-only support was associated with higher 30-day mortality compared to IABP-only support, but this likely reflects the severity of illness in ECMO patients. Younger age and greater cardiac arrest prevalence in the ECMO group highlight the importance of patient selection. While ECMO may benefit high-risk cases, careful evaluation is required to optimize outcomes. These findings align with prior studies suggesting ECMO benefits in selected populations, though further trials are needed to clarify its role.</span></span></span></p>
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