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Coronary artery bypass grafting versus percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock - 16/08/20

Doi : 10.1016/j.ahj.2020.01.020 
Nathaniel R. Smilowitz, MD, MS a, b, , Carlos L. Alviar, MD a, Stuart D. Katz, MD a, Judith S. Hochman, MD a
a Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY 
b Division of Cardiology, Department of Medicine, Veterans Affairs New York Harbor Health Care System, New York, NY 

Reprint requests: Nathaniel R. Smilowitz, MD, MS, Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, 423 East 23rd Street, Room 12,020-W, New York, NY 10010.Division of Cardiology, Department of MedicineNew York University School of Medicine423 East 23rd Street, Room 12,020-WNew YorkNY10010

Abstract

Background

Myocardial infarction (MI) complicated by cardiogenic shock (CS) is associated with high mortality. Early coronary revascularization improves survival, but the optimal mode of revascularization remains uncertain. We sought to characterize practice patterns and outcomes of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients with MI complicated by CS.

Methods

Patients hospitalized for MI with CS between 2002 and 2014 were identified from the United States National Inpatient Sample. Trends in management were evaluated over time. Propensity score matching was performed to identify cohorts with similar baseline characteristics and MI presentations who underwent PCI and CABG. The primary outcome was in-hospital all-cause mortality.

Results

A total of 386,811 hospitalizations for MI with CS were identified; 67% were STEMI. Overall, 62.4% of patients underwent revascularization, with PCI in 44.9%, CABG in 14.1%, and a hybrid approach in 3.4%. Coronary revascularization for MI and CS increased over time, from 51.5% in 2002 to 67.4% in 2014 (P for trend < .001). Patients who underwent CABG were more likely to have diabetes mellitus (35.5% vs. 29.2%, P < .001) and less likely to present with STEMI (48.7% vs. 80.9%, P < .001) than those who underwent PCI. CABG (without PCI) was associated with lower mortality than PCI (without CABG) overall (18.9% vs. 29.0%, P < .001) and in a propensity-matched subgroup of 19,882 patients (19.0% vs. 27.0%, P < .001).

Conclusions

CABG was associated with lower in-hospital mortality than PCI among patients with MI complicated by CS. Due to the likelihood of residual confounding, a randomized trial of PCI versus CABG in patients with MI, CS, and multi-vessel coronary disease is warranted.

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 Sponsor / Funding: Dr Smilowitz is supported in part by an NYU CTSA grant, UL1 TR001445 and KL2 TR001446, from the National Center for Advancing Translational Sciences, National Institutes of Health.


© 2020  Pubblicato da Elsevier Masson SAS.
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Vol 226

P. 255-263 - Agosto 2020 Ritorno al numero
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