Association Between Extracorporeal Cardiopulmonary Resuscitation and Prognosis in the Short and Long Term in Patients With Acute Myocardial Infarction Complicated by Refractory Cardiac Arrest

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Abstract
Background: Although extracorporeal cardiopulmonary resuscitation (ECPR) is expected to improve outcomes in patients with cardiac arrest (CA), its impact on prognosis in acute myocardial infarction (MI) patients complicated by CA remains unclear. This study aimed to investigate the short- and long-term effects of ECPR on prognosis in these patients.Methods and Results: This single-center, retrospective study analyzed consecutive MI patients. Patients were classified into 3 groups: CA requiring ECPR (ECPR group); CA achieving return of spontaneous circulation without ECPR (CCPR group); and without CA (non-CA group). The primary endpoint was 30-day mortality, while long-term all-cause mortality, cardiovascular death, and major adverse cardiovascular events were evaluated among discharged patients. Of the 625 patients analyzed, 57 were in the ECPR group, 104 in the CCPR group, and 464 in the non-CA group. Multivariable analysis revealed that the ECPR group had a significantly higher prevalence of 30-day mortality than the CCPR group (adjusted hazard ratio [HR] 3.99; 95% confidence interval [CI] 2.23–7.13) and the non-CA group (HR 43.48; 95% CI 19.70–95.92). However, there were no significant differences in long-term outcomes among the 3 groups.Conclusions: The 30-day mortality was worse in the ECPR group than in the CCPR or non-CA groups. In contrast, the long-term prognosis was comparable among discharged patients, regardless of the presence of CA or the need for ECPR.

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