Prophylactic Use of V-A ECMO During High-Risk Percutaneous Coronary Interventions: A Single-Center Study

Abstract

Background. High-risk percutaneous coronary interventions (high-risk PCI) in patients with complex coronary artery disease and reduced left ventricular systolic function are associated with a substantial risk of hemodynamic instability and periprocedural complications. Mechanical circulatory support may improve the safety of these procedures by maintaining adequate systemic perfusion during technically demanding stages of the intervention. Objective: To evaluate the safety and results of prophylactic veno-arterial extracorporeal membrane oxygenation (V-A ECMO) during high-risk PCI in patients with coronary artery disease and to identify factors associated with in-hospital mortality. Methods. A single-center retrospective observational study was conducted, including consecutive patients who underwent elective high-risk PCI with prophylactic V-A ECMO support between 2019 and 2025. The primary endpoint was in-hospital mortality. We used logistic regression to identify predictors of mortality. Results. A total of 43 patients were included in the analysis (mean age 66.1 ± 8.9 years; 74.4% male). The mean left ventricular ejection fraction was 31.9 ± 6.8%, and the mean SYNTAX score was 32.4 ± 6.8. Successful revascularization was achieved in 90.7% of cases, and ECMO weaning at the end of the procedure was possible in 88.4% of patients. In-hospital mortality was 14.0%. Major bleeding occurred in 20.9% of patients, vascular complications in 11.6%, and acute kidney injury in 23.3%. In multivariable analysis, the maximum vasoactive-inotropic score (VIS) was identified as an independent predictor of in-hospital mortality (OR 1.10; 95% CI 1.01–1.21; p = 0.041). Conclusions. Prophylactic V-A ECMO enabled elective high-risk PCI in a highly selected cohort with complex coronary anatomy and impaired left ventricular function. However, the substantial in-hospital mortality and complication rates, together with the retrospective design and absence of a control group, preclude conclusions regarding clinical effectiveness. Prospective controlled studies are required to determine whether prophylactic V-A ECMO improves outcomes compared with unsupported PCI or other mechanical circulatory support strategies.