Background
. While only a small minority of patients undergo coronary artery bypass surgery (CABG) in the setting of cardiogenic shock (CS), these patients face a high risk for mortality and morbidity. There exist few studies that characterize clinical features and outcomes in CS patients undergoing CABG in contemporary community practice.
Methods
. We evaluated data of 14,956 patients with CS in comparison with 693637 without CS undergoing CABG between 2002 and 2005 at hospitals participating in the Society of Thoracic Surgeons National Database. Clinical, angiographic and operative features and in-hospital outcomes were studied in patients with and without CS.
Results
. Patients with preoperative CS constituted 2.1% of patients undergoing CABG yet accounted for 16% of all CABG deaths. These patients had greater comorbid conditions and left main disease and lower left ventricular ejection fraction. In-hospital events and length of hospital stay (median 96 vs. 36 days) were significantly higher in CS patients. Operative mortality was high (rising from 20% for isolated CABG, to 33% for CABG+ valve surgery, to 58% for CABG+ ventricular septal repair). While mortality for CABG surgery overall has declined significantly overtime (p for trend< .0001), mortality for CS patients have not changed significantly over the 4 year study period (p= .07, Figure
).
Conclusions
. Patients with CS represents minority of patients undergoing CABG, yet with persistently high operative risks. These patients in fact account for 1 of every 7 deaths in patients undergoing CABG. Ongoing efforts are warranted to continuously develop and evaluate new strategies to improve outcomes of these patients.
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
