No Benefit of ECLS in Myocardial Infarction Plus Cardiogenic Shock

Aug 31, 2023

Adding extracorporeal life support to standard care did not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock.

The addition of extracorporeal life support (ECLS) to standard medical therapy did not reduce all-cause mortality in patients with acute myocardial infarction (MI) and cardiogenic shock, challenging current guideline recommendations, a study found.

“Although the use of ECLS has been increasing in the context of treating infarct-related cardiogenic shock, there is insufficient evidence for its effect on mortality,” explained Holger Thiele, MD, at ESC Congress 2023. To evaluate ECLS in this setting, the ECLS-SHOCK trial randomly assigned 420 patients with acute MI complicated by cardiogenic shock 1:1 to ECLS plus standard medical therapy or to standard medical therapy only. The primary endpoint was 30-day all-cause mortality.

There was no significant difference in all-cause mortality between the ECLS arm and the control arm (47.8% vs 49.0%; RR, 0.98; 95% CI, 0.80–1.19; P=0.81). Dr. Thiele added that secondary outcomes such as arterial lactate, renal function, and simplified acute physiology score (SAPS II) confirmed that there was no difference between both treatment groups. However, there was an increased risk for moderate to severe bleeding in participants receiving ECLS compared with those in the control arm (23.4% vs 9.6%; RR, 2.44; 95% CI, 1.50–3.95; P<0.05). Similarly, the ECLS arm showed higher rates of peripheral ischemic vascular complications requiring surgical or interventional therapy (11.0% vs 3.8%; RR, 2.86; 95% CI, 1.31-6.25; P<0.05).

The authors also performed a meta-analysis on the four trials investigating ECLS in this setting (ECLS-SHOCK 1, ECMO-CS, EURO SHOCK, and ECLS-SHOCK) and found no effect on all-cause mortality by omitting this therapy (OR, 0.93; 95% CI, 0.66–1.29).