Coronary artery bypass graft surgery provides better survival in patients with acute coronary syndrome or ST-segment elevation myocardial infarction experiencing cardiogenic shock after percutaneous coronary intervention: A propensity score analysis

Objective

The objective of this study was to find the best treatment strategy in patients who had acute coronary syndrome and ST-segment elevation myocardial infarction sustaining cardiogenic shock.

Methods

Patients having cardiogenic shock owing to acute coronary syndrome and ST-segment elevation myocardial infarction who required hemodynamic support with intra-aortic balloon counterpulsation were retrospectively retrieved from the clinical information system in a tertiary medical center in Taiwan. A propensity score–based matching process was applied to find equalized groups with documented involvement of more than 2 coronary vessels who received percutaneous coronary intervention only (PCI only group) and who underwent subsequent coronary artery bypass graft surgery after percutaneous coronary intervention (PCI+CABG group). A logistic regression model was used to find the factors associated with 30-day mortality.

Results

The propensity analysis identified 44 patients in the PCI only group (35 men, 65 ± 2 years, and 9 women, 75 ± 4 years) and the other 44 patients in the PCI+CABG group (31 men, 67 ± 2 years, and 13 women, 71 ± 2 years) who had comparable baseline characteristics. The 30-day mortality, 40.9% in the PCI only group and 20.5% in the PCI+CABG group, was positively associated with percutaneous coronary intervention only (odds ratio, 3.33; 95% confidence intervals, 1.14–10.0; P = .03), increased age (odds ratio, 1.06 for each year; 95% confidence intervals, 1.01–1.12; P = .01) and a need to use extracorporeal membrane oxygenation (odds ratio, 9.64; 95% confidence intervals, 2.19–42.4; P < .001).

Conclusions

This study has shown the survival benefit of surgical intervention in high-risk patients with acute coronary syndrome or ST-segment elevation myocardial infarction who had cardiogenic shock after percutaneous coronary intervention.

CTSNet classification: 30

Abbreviations and Acronyms: ACS, acute coronary syndrome, ALKK, Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte, CABG, coronary artery bypass graft surgery, 95% CI, 95% confidence intervals, ECMO, extracorporeal membrane oxygenation, GUSTO, Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries, IABP, intra-aortic balloon pumping, OR, odds ratio, PCI, percutaneous coronary intervention, SHOCK, SHould we emergently revascularize Occluded Coronaries for cardiogenic shock, STEMI, ST-segment elevation myocardial infarction, TIMI, Thrombolysis In Myocardial Infarction