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Published on: August 16, 2021
Coronary Artery Bypass Grafting in Patients with Acute Myocardial Infarction and Cardiogenic Shock
Christina Grothusen1,2, Christine Friedrich1, Ulysses Ulbricht1
1Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, 24105 Kiel, Germany.
Insights
Coronary artery bypass grafting (CABG) within 48 hours of acute myocardial infarction (AMI) and cardiogenic shock (CS) shows comparable outcomes to other treatments, suggesting CABG is a viable option for complex cases.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) has high mortality.
- Coronary artery bypass grafting (CABG) is rarely used in CS due to peri-operative risk concerns.
Purpose of the Study:
- To analyze the outcomes of CS patients undergoing urgent CABG (within 48 hours) after AMI diagnosis.
Main Methods:
- Retrospective analysis of 220 AMI patients with CS who underwent CABG between 2001 and 2018.
- Patients were stratified by ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI).
Main Results:
- No significant differences in 30-day mortality (32.6% STEMI vs. 31.6% NSTEMI) or post-operative complications were observed between STEMI and NSTEMI groups.
- Complete revascularization was achieved in most patients (82.3% STEMI, 73.4% NSTEMI).
- Rates of low cardiac output and cerebrovascular injury were similar across groups.
Conclusions:
- Urgent CABG in AMI patients with CS is a feasible treatment option, even with complex coronary artery disease.
- CABG outcomes in this high-risk population are comparable to expectations, challenging the reluctance to perform it.
- Further research into percutaneous coronary interventions (PCI) versus CABG in AMI with CS is warranted.
Objective:
Acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains associated with a high rate of mortality and disabling morbidity. Coronary artery bypass grafting (CABG) is seldom considered in this setting due to the fear of peri-operative complications. Here, we analysed the outcome of CS patients undergoing CABG within 48 hours after diagnosed with AMI.
Methods:
A single-center, retrospective data analysis was performed in 220 AMI patients with CS that underwent CABG within 48 hours between 01/2001 and 01/2018.
Results:
141 patients were diagnosed with ST-elevation myocardial infarction (STEMI), 79 with non-STEMI (NSTEMI). Median age was 67 (60; 72) for STEMI, and 68 (60.8; 75.0) years for NSTEMI patients (p = 0.190). 52.5% of STEMI patients and 39.2% of NSTEMI patients had suffered from cardiac arrest (CA) pre-operatively (p = 0.049). Coronary 3-vessel disease was present in most patients (78.0% STEMI vs 83.5% NSTEMI; p = 0.381). Percutaneous coronary interventions (PCI) were performed in 32.6% STEMI and 27.8% NSTEMI patients (p = 0.543) prior to surgery. Time from diagnosis to surgery was shorter in STEMI patients (3.92 (2.67; 5.98) vs 7.50 (4.78; 16.74) hours; p 0.001). A complete revascularization was achieved in 82.3% of STEMI and 73.4% of NSTEMI cases (p = 0.116). Post-operative low cardiac output occurred in 14.2% of STEMI vs 8.9% of NSTEMI patients (p = 0.289). The rate of cerebrovascular injury-including hypoxic brain damage was 12.1% for STEMI and 10.1% among NSTEMI patients. (p = 0.825). 30-day mortality was 32.6% after STEMI vs 31.6% in NSTEMI cases (p = 0.285).
Conclusions:
In contrast to the discouraging data concerning the role of PCI in AMI patients with CS and complex coronary artery disease, CABG may represent a treatment option worth considering.
