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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
07:39

Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock

Published on: August 16, 2021

Outcome after surgery and percutaneous intervention for cardiogenic shock and left main disease

Michael S Lee1, Chi-Hong Tseng, Colin M Barker

  • 1Division of Cardiology, University of California, Los Angeles Medical Center, Los Angeles, CA 90095-171715, USA. mslee@mednet.ucla.edu

The Annals of Thoracic Surgery
|June 25, 2008
PubMed

Insights

Coronary artery bypass graft surgery (CABG) showed better 30-day survival than percutaneous coronary intervention (PCI) for patients with left main coronary artery disease and cardiogenic shock. Further research is needed on current PCI strategies for this critical patient group.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Cardiac Surgery

Background:

  • The optimal revascularization strategy for patients experiencing cardiogenic shock due to left main coronary artery disease remains unclear.
  • This study addresses the comparative effectiveness of bypass surgery versus percutaneous coronary intervention (PCI) in this high-risk population.

Purpose of the Study:

  • To compare the 30-day survival rates between coronary artery bypass graft surgery (CABG) and PCI in patients with left main coronary artery disease presenting with cardiogenic shock.
  • To identify independent predictors of survival in this patient cohort.

Main Methods:

  • Analysis of data from the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock Trial and Registry, including 164 patients with left main disease.
  • Individualized revascularization strategy selection by site investigators, comparing 79 CABG cases with 85 PCI cases.

Main Results:

  • Coronary artery bypass graft surgery was associated with significantly higher 30-day survival (54%) compared to PCI (14%) in patients with left main coronary artery disease and cardiogenic shock (p
  • When the left main artery was the infarct-related artery, 30-day survival was 40% with CABG versus 16% with PCI (p = 0.03).
  • Independent predictors of 30-day survival included CABG (hazard ratio, 0.41) and age.

Conclusions:

  • Coronary artery bypass graft surgery demonstrated a survival advantage over PCI at 30-day follow-up for patients with left main coronary artery disease and cardiogenic shock.
  • The long-term impact and effectiveness of contemporary PCI strategies in this specific subgroup require further investigation.
Abstract

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