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J Thorac Cardiovasc Surg 2009;138:1326-1330
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Coronary artery bypass graft surgery provides better survival in patients with acute coronary syndrome or ST-segment elevation myocardial infarction experiencing cardiogenic shock after percutaneous coronary intervention: A propensity score analysis

^a National Taiwan University Hospital Yun-Lin Branch, Dou-Liou City, Yun-Lin County, Taiwan
^b National Taiwan University Hospital, Taipei, Taiwan

Received for publication October 23, 2008; revisions received February 24, 2009; accepted for publication March 20, 2009.

^_* Address for reprints: Jou-Wei Lin, MPH, MD, PhD, Cardiovascular Center, National Taiwan University Hospital Yun-Lin Branch, 579 Yun-Lin Rd, Section 2, Dou-Liou City, Yun-Lin County, Taiwan, 640, or Yih-Sharng Chen, MD, PhD, Section of Cardiovascular Surgery, Department of Surgery, National Taiwan University Hospital, 7 Chung-Shan S. Rd, Section 1, Taipei, Taiwan 100. (Email: uenling{at}hotmail.com; jouweilin{at}yahoo.com).

Objective: The objective of this study was to find the best treatment strategy in patients who had acute coronary syndrome and ST-segment elevation myocardial infarction sustaining cardiogenic shock.

Methods: Patients having cardiogenic shock owing to acute coronary syndrome and ST-segment elevation myocardial infarction who required hemodynamic support with intra-aortic balloon counterpulsation were retrospectively retrieved from the clinical information system in a tertiary medical center in Taiwan. A propensity score–based matching process was applied to find equalized groups with documented involvement of more than 2 coronary vessels who received percutaneous coronary intervention only (PCI only group) and who underwent subsequent coronary artery bypass graft surgery after percutaneous coronary intervention (PCI+CABG group). A logistic regression model was used to find the factors associated with 30-day mortality.

Results: The propensity analysis identified 44 patients in the PCI only group (35 men, 65 ± 2 years, and 9 women, 75 ± 4 years) and the other 44 patients in the PCI+CABG group (31 men, 67 ± 2 years, and 13 women, 71 ± 2 years) who had comparable baseline characteristics. The 30-day mortality, 40.9% in the PCI only group and 20.5% in the PCI+CABG group, was positively associated with percutaneous coronary intervention only (odds ratio, 3.33; 95% confidence intervals, 1.14–10.0; P = .03), increased age (odds ratio, 1.06 for each year; 95% confidence intervals, 1.01–1.12; P = .01) and a need to use extracorporeal membrane oxygenation (odds ratio, 9.64; 95% confidence intervals, 2.19–42.4; P < .001).

Conclusions: This study has shown the survival benefit of surgical intervention in high-risk patients with acute coronary syndrome or ST-segment elevation myocardial infarction who had cardiogenic shock after percutaneous coronary intervention.

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