Clinical characteristics and in-hospital outcomes of patients with cardiogenic shock undergoing coronary artery...

Area of Science:

• Cardiovascular Surgery
• Critical Care Medicine
• Health Services Research

Background:

• Limited data exists on contemporary clinical features and outcomes for cardiogenic shock (CS) patients undergoing coronary artery bypass grafting (CABG).
• Risk factors for operative mortality in this specific patient group remain undercharacterized.

Purpose of the Study:

• To characterize clinical features and outcomes of CS patients undergoing CABG.
• To identify predictors of operative mortality in CS patients undergoing CABG.
• To develop a risk score for predicting operative mortality in CS patients undergoing CABG.

Main Methods:

• Analysis of 708,593 patients undergoing CABG from the Society of Thoracic Surgeons National Cardiac Database (2002-2005).
• Evaluation of clinical, angiographic, and operative features and in-hospital outcomes in patients with and without CS.
• Logistic regression to identify mortality predictors and develop an additive risk score.

Main Results:

• CS patients (2.1% of CABG cohort) accounted for 14% of all CABG deaths.
• Operative mortality for CS patients was high and surgery-specific (20% for isolated CABG to 58% for CABG plus ventricular septal repair).
• Mortality for CS patients undergoing CABG did not significantly change over time, unlike overall CABG mortality.
• A bedside risk score (c-statistic=0.74) accurately stratified CS patients by mortality risk.

Conclusions:

• CS patients undergoing CABG represent a small proportion but have persistently high operative risks and contribute significantly to CABG-related deaths.
• A simplified additive risk tool using preprocedural data can estimate patient-specific mortality risk for CS patients undergoing CABG.