Extracorporeal Circulatory Support in Acute Coronary Syndromes: A Systematic Review and Meta-Analysis

Abstract

Objective: Extracorporeal circulatory support (ECS) is a life-saving technique and its use is increasing in acute coronary syndromes (ACS). A meta-analysis on pooled event rate of short-term mortality and complications of ACS patients treated with ECS was performed. Data sources: Articles were searched in MEDLINE, Cochrane Library, Google Scholar and Biomed Central. Study selection: Inclusion criteria: observational studies on ACS patients treated with ECS. Primary outcome: short-term mortality. Secondary outcomes: ECS-related complications, causes of death, long-term mortality and bridge therapy. Data extraction: Sixteen articles were selected. Data about clinical characteristics, ACS diagnosis and treatment, ECS setting, outcome definitions and event rate were retrieved from the articles. Random-effect meta-analytic pooling was performed reporting results as a summary point estimate and 95% confidence interval. Data synthesis: A total of 739 patients were included (mean age 59.8 ±2.9). The event rate of short-term mortality was 58% (95% CI, 51-64%), 6-month mortality was affecting 24% (95%CI, 5%-63%) of 1-month survivors and 1-year mortality 17% (95%CI, 6%-40%) of 6-month survivors. The event rates of ECS-related complications were: acute renal failure 41%, bleeding 25%, neurologic damage in survivors 21%, sepsis/infections 21% and leg ischemia 12%. Between causes of death, multiorgan failure and brain death affected respectively 40% and 27% of patients. Bridge to ventricular assistance device was offered to 14% of patients and 7% received a transplant. Conclusions: There is still a high rate of short-term mortality and complications in ACS patients treated with ECS. New studies are needed to optimize and standardize ECS.