Venoarterial Extracorporeal Membrane Oxygenation Timing in Infarct-Related Cardiogenic Shock: Before Versus After Primary Percutaneous Coronary Intervention

The optimal timing for venoarterial extracorporeal membrane oxygenation (VA-ECMO) initiation in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) remains unclear. This study evaluated whether initiating VA-ECMO before primary percutaneous coronary intervention (PCI) improves survival compared with post-PCI initiation in patients with AMICS. We performed a single-center retrospective cohort study using registry data from 113 patients with AMICS who received VA-ECMO. The patients were classified into ECMO pre-PCI (n = 72) and ECMO post-PCI (n = 41) groups. The 30-day mortality rate in the ECMO pre-PCI group (29.2%) was lower than that in the ECMO post-PCI group (61.0%) (adjusted hazard ratio [HR], 0.32; 95% confidence interval [CI], 0.17-0.60; p < 0.001) and remained consistent across most subgroups. The ECMO pre-PCI group was also associated with lower in-hospital (27.8% vs. 61.0%; adjusted odds ratio, 0.20; 95% CI, 0.08-0.48; p < 0.001), 180-day (36.1% vs. 63.4%; adjusted HR, 0.36; 95% CI, 0.20-0.65; p < 0.001), and 360-day (40.3% vs. 65.9%; adjusted HR, 0.37; 95% CI, 0.21-0.66; p <0.001) mortality. In selected patients with AMICS, initiating VA-ECMO support before primary PCI may reduce short- and long-term mortality compared with initiating support after primary PCI. These findings highlight the potential significance of early hemodynamic stabilization and warrant further prospective studies.