Early extracorporeal life support (ECLS) does not improve survival in patients with acute myocardial infarction complicated by cardiogenic shock who are scheduled for early revascularization, according to late breaking research presented in a Hot Line session at ESC Congress 2023.
scheduled for early revascularization were enrolled from 44 centers in Germany and Slovenia. The median age of participants was 63 years and 19% were women. Patients were randomly assigned to early ECLS plus usual medical treatment or to usual medical treatment alone .
The primary endpoint was all-cause death at 30 days. Secondary endpoints included length of mechanical ventilation, time to hemodynamic stabilization and need for renal replacement therapy. Safety endpoints included moderate or severe bleeding and peripheral vascular complications requiring intervention
A total of 417 patients were included in the final analyses. The primary endpoint of all-cause death at 30 days occurred in 100 of 209 patients in the ECLS group and in 102 of 208 patients in the control group . The median duration of mechanical ventilation was longer in the ECLS group: seven days in the ECLS group versus five days in the control group, Hodges-Lehmann estimate of the difference between groups, 1 . The time to hemodynamic stabilization and rates of renal replacement therapy were similar between treatment groups.
Regarding safety endpoints, moderate or severe bleeding occurred more frequently in the ECLS group: 23.4% of patients in the ECLS group versus 9.6% of patients in the control group . Peripheral vascular complications requiring intervention occurred also more often in the ECLS group: 11.0% of patients in the ECLS group versus 3.
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