Impact of ECPELLA Support on Mid-Term Survival and IABP-Shock II Score in Patients With Refractory Cardiogenic Shock Due to Acute Coronary Syndrome

Introduction: The prognosis remains extremely poor for acute coronary syndrome (ACS) with cardiogenic shock (CS) who required VA-ECMO. The IABP-SHOCK II score is a simple tool, and has demonstrated a high predictive ability for assessing the prognosis of patients with CS. Objective: To evaluate the impact of ECPELLA on intermediate-term survival compared to VA-ECMO with IABP support in patients with ACS and refractory CS and to assess the utility of the IABP-SHOCK II score in predicting outcomes for patients requiring VA-ECMO support. Methods: From January 2012 to December 2022, we enrolled 90 consecutive patients with ACS-CS who received VA-ECMO. Patents were divided into two groups; 44 patients received ECPELLA, and 46 patients received VA-ECMO with IABP. We assessed IABP-SHOCK II score and 180-day all-cause mortality. Results: There were no significant differences in age, rate of male sex, coronary risk factors, ST-elevated ACS, LMT lesion, extracorporeal cardiopulmonary resuscitation, and IABP-SHOCK II score between two groups. Kaplan-Meier analysis revealed that ECPELLA was associated with a significantly higher 180-day survival rate (p = 0.001). The patients were categorized into three groups based on the IABP-SHOCK II score: low (0-2), intermediate (3-4), and high (5-9). The IABP-SHOCK II risk score successfully stratified only the ECPELLA group into different risk categories for 30-day prognostic assessment. Conclusions: ECPELLA was associated with favorable mid-term survival compared to VA-ECMO with IABP support. Additionally, the IABP-SHOCK II score proved to be a useful tool for predicting mortality in patients treated with ECPELLA.