Clinical Characteristics and Outcomes of Patients With Myocardial Infarction and Cardiogenic Shock Undergoing Coronary Artery Bypass Surgery: Data From The Society of Thoracic Surgeons National Database

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• 作者：Deepak Acharya ; MD ; MSPH^a ; ^{dacharya@uab.edu" class="auth_mail" title="E-mail the corresponding author} ; Brian C. Gulack ; MD^b ; Renzo Y. Loyaga-Rendon ; MD ; PhD^a ; James E. Davies ; MD^c ; Xia He ; MS^d ; J. Matthew Brennan ; MD ; MPH^e ; Vinod H. Thourani ; MD^f ; Matthew L. Williams ; MD^g
• 关键词：ACSD ; Adult Cardiac Surgery Database ; AMI-CS ; acute myocardial infarction complicated by cardiogenic shock ; CABG ; coronary artery bypass graft surgery ; ECMO ; extracorporeal membrane oxygenation ; IABP ; intraaortic balloon pump ; LVAD ; left ventricular assist device ; LVEF ; left ventricular ejection fraction ; MCS ; mechanical circulatory support ; MI ; myocardial infarction ; PCI ; percutaneous coronary intervention ; STS ; The Society of Thoracic Surgeons ; VAD ; ventricular assist device
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：101
• 期：2
• 页码：558-566
• 全文大小：680 K

文摘

Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with substantial mortality. We evaluated outcomes of patients in The Society of Thoracic Surgeons Adult Cardiac Surgery Database who underwent coronary artery bypass graft surgery (CABG) in the setting of AMI-CS.

Methods

All patients with AMI-CS who underwent nonelective CABG or CABG with ventricular assist device implantation within 7 days after myocardial infarction were enrolled. The primary analysis sample consisted of patients who underwent surgery between June 2011 and December 2013. Baseline characteristics, operative findings, outcomes, and the utilization of mechanical circulatory support (MCS) were assessed in detail in this population. We also evaluated trends in unadjusted mortality for all patients undergoing CABG or CABG with ventricular assist device for AMI-CS from January 2005 to December 2013.

Results

A total of 5,496 patients met study criteria, comprising 1.5% of all patients undergoing CABG during the study period. Overall operative mortality was 18.7%, decreasing from 19.3% in 2005 to 18.1% in 2013 (p < 0.001). Use of MCS increased from 5.8% in 2011 to 8.8% in 2013 (p = 0.008). Patients receiving MCS had a high proportion of cardiovascular risk factors or high clinical acuity. Patients requiring preoperative and patients requiring intraoperative or postoperative MCS had operative mortality of 37.2% and 58.4%, respectively. Patients undergoing CABG as a salvage procedure had an operative mortality of 53.3%, and a high incidence of reoperation (21.8%), postoperative respiratory failure requiring prolonged ventilation (59.7%), and renal failure (18.5%).

Conclusions

Most patients undergoing CABG for AMI-CS have a sizeable but not prohibitive risk. Patients who require MCS and those undergoing operation as a salvage procedure reflect higher risk populations.