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
Received 23 October 2008; received in revised form 24 February 2009; accepted 20 March 2009. published online 11 June 2009.
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.
aNational Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan
bNational Taiwan University Hospital, Taipei, Taiwan
Address for reprints: Jou-Wei Lin, MPH, MD, PhD, Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, 579 Yun-Lin Rd, Section 2, Dou-Liou City, Yun-Lin County, Taiwan, 640, or Yih-Sharng Chen, MD, PhD, Section of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan S. Rd, Section 1, Taipei, Taiwan 100.
∗ F.-C.C. and S.-N.C. contributed equally to this work.
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