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Published on: June 12, 2021
Outcomes of Percutaneous Coronary Intervention for Cardiogenic Shock After Coronary Artery Bypass Graft
Usman Ali Akbar1, Haisum Maqsood2, Alpesh R Shah2
1Camden Clark Medical Center, West Virginia University, Parkersburg, West Virginia.
Insights
Percutaneous coronary intervention (PCI) after coronary artery bypass graft (CABG) surgery significantly reduced 30-day mortality and adverse cardiovascular events in patients with cardiogenic shock. This study highlights PCI
Area of Science:
- Cardiology and Cardiovascular Research
- Interventional Cardiology
- Health Services Research
Background:
- Coronary artery bypass graft (CABG) surgery is a major cardiovascular procedure.
- Cardiogenic shock following CABG presents a high-risk scenario with significant mortality.
- The role of early percutaneous coronary intervention (PCI) in managing cardiogenic shock post-CABG requires further elucidation.
Purpose of the Study:
- To evaluate the association between early PCI (within 24 hours) and 30-day outcomes in patients experiencing cardiogenic shock after CABG surgery.
- To compare mortality and major adverse cardiovascular events between patients who received PCI and those who did not.
Main Methods:
- Retrospective cohort study utilizing the United States TriNetX database (2006-2025).
- Inclusion of adult patients with myocardial infarction and cardiogenic shock during hospitalization after CABG.
- Propensity score matching and Fine-Gray models were employed to adjust for confounders, with 30-day all-cause mortality as the primary endpoint.
Main Results:
- PCI was associated with significantly lower 30-day all-cause mortality (4.5% vs. 5.7%) compared to no PCI.
- Patients undergoing PCI showed reduced rates of myocardial infarction (MI), stroke, heart failure (HF), and all-cause hospitalization.
- Adjusted analyses consistently demonstrated the benefits of PCI, with no association found for a bone fracture falsification endpoint.
Conclusions:
- Early percutaneous coronary intervention (PCI) following coronary artery bypass graft (CABG) surgery is associated with improved 30-day survival and better cardiovascular outcomes in patients with cardiogenic shock.
- These findings suggest PCI as a potentially beneficial therapeutic strategy in this high-risk population.
- Further prospective studies are warranted to confirm these hypothesis-generating results.
Abstract:
We conducted a retrospective cohort study of adults with myocardial infarction (MI) and cardiogenic shock during the index hospitalization after coronary artery bypass graft (CABG) surgery using the United States TriNetX (2006 to 2025) database, comparing those who underwent percutaneous coronary intervention (PCI: ≤24 h) to those who did not. Outcomes were reported as unadjusted and adjusted hazard ratios (HRs) or subdistribution HRs (sHRs) using propensity score matching and Fine-Gray models. The primary endpoint was 30-day all-cause mortality. Secondary endpoints included 30-day hospitalizations for MI, stroke, heart failure (HF), and all-cause hospitalization. Sensitivity analyses included a falsification endpoint (bone fracture) and landmark analyses by PCI timing (≤12 h vs 12 to 24 h). Among 218,827 patients, 22,762 underwent PCI. Compared with those who did not undergo PCI, PCI was associated with lower rates of all-cause mortality (4.5% vs 5.7%), MI (5.0% vs 7.0%), stroke (2.5% vs 5.0%), HF (15.0% vs 28.0%), and all-cause hospitalization (20.0% vs 28.0%). These estimates remained consistent after adjustment for all-cause mortality (HR, 0.88 [95% CI, 0.80 to 0.96]), MI (sHR 0.86 [0.79 to 0.94]), stroke (sHR 0.41 [0.37 to 0.46]), HF (sHR 0.52, 0.50 to 0.55), and all-cause hospitalization (sHR 0.70 [0.67 to 0.73]). PCI showed no association with hospitalization for bone fracture (HR, 0.82 [0.62 to 1.10). Landmark analyses revealed similar trends for mortality at both ≤12 h and 12 to 24 h intervals. In conclusion, PCI was associated with lower 30-day mortality and cardiovascular outcomes after CABG-related cardiogenic shock. These findings are hypothesis-generating and warrant confirmation in prospective studies.
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