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Could Selective Re-look Angiography Improve the Outcome of Cardiogenic Shock in Patients Under Veno-arterial Extracorporeal Membrane Oxygenator?

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Abstract

It is not well studied whether a secondary look by angiography (Re-Ang) after fixing the culprit lesion would be beneficial or not in cardiogenic shock (CS) supported by veno-arterial extracorporeal membrane oxygenator (VA-ECMO). This study was a retrospective observational one that looked at 5-year data from a single tertiary center. Patients were grouped according to the need of Re-Ang during the VA-ECMO course into 2 groups. The indications to perform Re-Ang were loss of pulse pressure, drop in ejection fraction or velocity time integral, resistant arrhythmia, or new electrocardiographic changes suggestive of ischemia. Out of 150 patients with cardiogenic shock screened, 30 patients were enrolled in our study. Re-Ang was done in 10 patients only. In 80% of them, positive findings were found in terms of new significant stenosis (3 patients), stent restenosis (1 patient), stent thrombosis (3 patients), and patent stent(s) with intervention to the remaining lesions in other vessels (1 patient). Neither successful weaning from VA-ECMO nor mortality was statistically different between both groups. Our set indications for Re-Ang were effective in finding a possible new culprit for a conceivable coronary intervention.

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Availability of Data and Materials

The data related to this manuscript and to its conclusions are available in the Hamad Medical Corporation Medical Research Center. The data is available on request to the corresponding author.

Abbreviations

ACT:

Activated clotting time

AF:

Atrial fibrillation

APTT:

Activated partial thromboplastin time

AMI:

Acute myocardial infarction

AKI:

Acute kidney injury

CAG:

Coronary angiogram

CS:

Cardiogenic shock

CVD:

Cardiovascular disease

ECG:

Electrocardiogram

EF:

Ejection fraction

HMC:

Hamad Medical Corporation

IABP:

Intra-aortic balloon pump

ICU:

Intensive care unit

LBBB:

Left bundle branch block

LV:

Left ventricle

LVOT:

Left ventricular outflow tract

MCS:

Mechanical circulatory support

PCI:

Percutaneous coronary intervention

RCT:

Randomized controlled trial

Re-Ang:

Re-look angiogram

STEMI:

ST-segment elevation myocardial infarction

TEE:

Transesophageal echocardiography

TTE:

Transthoracic echocardiography

tMCS:

Temporary mechanical circulatory support

VA-ECMO:

Veno-arterial extracorporeal membrane oxygenation

VF:

Ventricular fibrillation

VTI:

Velocity time integral

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Acknowledgements

This work would not have been possible without the kind support and help of many individuals and our organization. The authors thank all members of the cardiothoracic surgery department, Heart Hospital, of Hamad Medical Corporation, Qatar, for providing necessary information regarding the project and for support. The authors also thank the members of the medical research department of Hamad Medical Corporation for their support throughout this project.

Funding

The study was funded by the Hamad Medical Corporation. The medical research center in Hamad Medical Corporation takes the account in the publication of this manuscript.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery/Cardiac Anaesthesia & ICU Section, Heart Hospital, Hamad Medical Corporation, Doha, PO: 3050, Qatar

    Maurice Maksoud, Amr S. Omar, Praveen Sivadasan, Tamer Abdalghafoor, Bassam Shoman, Rula Taha & Abdulaziz AlKhulaifi

  2. Department of Critical Care Medicine, Beni Suef University, Beni Suef, Egypt

    Amr S. Omar

  3. Weill Cornell Medical College-Qatar, Ar-Rayyan, Qatar

    Amr S. Omar

  4. Department of Clinical Pharmacy, Heart Hospital, Hamad Medical Corporation, Doha, Qatar

    Alaa Rahhal

  5. Faculty of Medicine, Qatar University, Doha, Qatar

    Tasnim Abdalla

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  1. Maurice Maksoud
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Contributions

MM: data collection, drafting the manuscript; ASO: writing the discussion, critical revision, submission PS data collection, data management, introduction and discussion, writing and manuscript revision; TA: data collection; AR: statistical analysis and revision; TA: writing the results and discussion sections; BS: revision; RT: revision, general clinical supervision; AE: critical revision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Amr S. Omar.

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Ethics Approval and Consent to Participate

This study was approved by medical research center in Hamad Medical Corporation. The ethical committee in Hamad Medical Corporation approved the study (reference number MRC-01–20-096). Informed consent was waived by the ethical review panel for all patients enrolled in the study. However, all study data were maintained anonymously.

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Not applicable.

Competing Interests

The authors declare no competing interests.

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Communicated by Associate Editor Navin Kumar Kapur oversaw the review of this article.

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Maksoud, M., Omar, A.S., Sivadasan, P. et al. Could Selective Re-look Angiography Improve the Outcome of Cardiogenic Shock in Patients Under Veno-arterial Extracorporeal Membrane Oxygenator?. J. of Cardiovasc. Trans. Res. 15, 268–278 (2022). https://doi.org/10.1007/s12265-022-10205-4

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