The International journal of artificial organs | 2021
Peak troponin predicts successful weaning from VA ECMO in patients with acute myocardial infarction complicated by cardiogenic shock.
Abstract
BACKGROUND\nIn patients treated for refractory cardiogenic shock (RCS) following acute myocardial infarction (AMI), predicting successful weaning from veno-arterial extracorporeal membrane oxygenation (VA ECMO) has important implications for decision-making and prognosis.\n\n\nMETHODS\nWe performed a retrospective review of adult VA ECMO patients with RCS complicating AMI at our institution from 2010 to 2019. We evaluated use of peak troponin I as a predictor of successful decannulation.\n\n\nRESULTS\nSixty-two patients were analyzed; mean age 61.1\u2009±\u20099.8\u2009years, 73% males, 62% presented with STEMI. Forty-five patients were successfully weaned (group I). Seventeen patients did not wean (group II); seven patients received a durable LVAD, 10 died. Patients from group I had significantly lower peak troponin I (89 vs 434\u2009ng/mL, p\u2009=\u20090.0001). Receiver operating characteristic curves showed a peak troponin I cutoff of 400\u2009ng/mL correctly classified patients by weaning status 90% of the time, with associated sensitivity of 71% and specificity of 98%. With each 50\u2009ng/mL increase in troponin I, the likelihood of weaning decreased by 33%.\n\n\nCONCLUSIONS\nPeak troponin I above 400\u2009ng/mL may be helpful in predicting unsuccessful weaning from VA ECMO support for refractory cardiogenic shock following myocardial infarction and facilitate triage decisions regarding need for advanced therapies.