复杂高危冠状动脉病变介入术中预防性使用IABP 与VA-ECMO疗效具有一致性

宁志鸿.复杂高危冠状动脉病变介入术中预防性使用IABP 与VA-ECMO疗效具有一致性[J].内科急危重症杂志,2024,30(6):508-511

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DOI：10.11768/nkjwzzzz.20240605

中文关键词: 主动脉内球囊反搏静脉-动脉体外膜肺氧合复杂高危有介入治疗指征的冠心病患者

英文关键词:

基金项目:国家自然科学基金（81700306）、湖南省自然科学基金（2022JJ30528）、湖南省教育厅优秀青年基金（21B0408）〖JP〗、湖南省卫生健康委重点指导课题（C202303019182）、湖南省卫生健康委国家临床重点专科重大科研专项（20230160）、2023年度湖南省社会科学成果评审委员会课题（XSP2023GLZ019）

作者	单位	E-mail
宁志鸿	南华大学附属第一医院	bestmanhhj@hotmail.com

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中文摘要:

摘要：目的：比较复杂高危有介入治疗指征的冠心病患者（CHIP）术中行主动脉内球囊反搏（IABP）或静脉-动脉体外膜肺氧合（VA-ECMO）对死亡率、主要不良心脏事件（MACE）等临床结局的影响。方法：收集在 IABP或 VA-ECMO支持下（拒绝外科手术治疗或被外科拒绝）的24例CHIP进行单中心回顾性研究。根据治疗方式分为IABP组（18例）和VA-ECMO组（6例），评估2组在MACE、围术期死亡率、院内死亡率、 30 d死亡率等方面的差异。结果：2组的基线特征均衡良好。2组患者的血流动力学不稳定发生率比较，差异无统计学意义（11.1% vs. 16.7%，P= 0.78）；MACE的综合结局比较，差异无统计学意义（38.9% vs. 33.3%， P= 0.64）。IABP组的围术期死亡率为27.8%，VA-ECMO组为33.3%，两者比较差异无统计学意义（P= 0.72）。两者院内死亡率与30d死亡率一致，IABP组为38.9%，VA-ECMO组为33.3%，两者比较差异无统计学意义（P= 0.64）。VA-ECMO组平均住院时间更长（P=0.02）。结论：CHIP术中使用IABP或VA-ECMO装置作为机械循环支持在血流动力学不稳定性和总体MACE发生率方面无显著差异，选择IABP或VA-ECMO或许不会改变CHIP的远期生存结果。

英文摘要:

Abstract Objective: To compare the impact of intra-aortic balloon pump (IABP) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) on clinical outcomes, including mortality and major adverse cardiac events (MACE), in patients with complex high-risk coronary artery disease (CHIP) undergoing percutaneous coronary intervention. Methods: This single-center retrospective study included 24 CHIP patients who were either unsuitable for or declined surgical intervention and received mechanical circulatory support with either IABP or VA-ECMO. Patients were divided into an IABP group (18 cases) and a VA-ECMO group (6 cases). Clinical outcomes, including MACE, perioperative mortality, in-hospital mortality, and 30-day mortality, were compared between the two groups. Results: Baseline characteristics were well balanced between the two groups. There was no statistically significant difference in the incidence of hemodynamic instability between the two groups (11.1% vs. 16.7%; P= 0.78). The composite outcome of MACE showed no statistically significant difference between the groups (38.9% vs. 33.3%; P= 0.64). The perioperative mortality rate was 27.8% in the IABP group and 33.3% in the VA-ECMO group, and the difference was not statistically significant (P= 0.72). The in-hospital mortality and 30-day mortality rates were consistent between the two groups, with 38.9% in the IABP group and 33.3% in the VA-ECMO group, and the difference was not statistically significant between the two groups (P= 0.64). The mean length of hospital stay was longer in the VA-ECMO group (P= 0.02). Conclusion: The use of IABP or VA-ECMO as mechanical circulatory support during CHIP procedures did not significantly differ in terms of hemodynamic stability or overall MACE outcomes. The choice between IABP and VA-ECMO may not significantly impact long-term survival outcomes in CHIP patients.