Impact of prior revascularization on the outcomes of patients presenting with ST-elevation myocardial infarction and cardiogenic shock.

BACKGROUND

Patient presenting with ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) have extremely high mortality rates.

OBJECTIVES

We sought to assess the impact of prior revascularization by either coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI) on the in-hospital and 12-month outcomes and compare them with revascularization-naïve patients.

METHODS AND

RESULTS

Between 1/2010 and 5/2017, a total of 241 consecutive patients were admitted to our institution with STEMI and CS as defined by New York State Percutaneous Coronary Interventions Reporting System (PCIRS) and underwent primary PCI. Baseline clinical, angiographic and procedural characteristics, as well as in-hospital outcomes were prospectively collected among all patients undergoing primary PCI as part of the New York State PCIRS data collection. Patients with a history of prior bypass graft surgery were older and had a history of heart failure, hypertension, dyslipidemia, and diabetes. The left anterior descending coronary artery was usually the culprit vessel in post PCI and revascularization naïve patients, whereas it was a vein graft in patients with a prior history of surgical bypass. In-hospital mortality rates were different in the three groups and there was no significant difference in major adverse cardiac and cerebrovascular events rates among the three groups (p = 0.87). Notably, revascularization-naïve patients had higher rates of major bleeding complications (p = 0.006). By multivariable analysis, only age (OR 1.03; CI = 1.0-1.06), a prior history of congestive heart failure (OR 4.36, CI = 1.04-18.38) and dyslipidemia (OR 0.32 CI = 0.15-0.64) were independent predictors of 12-month mortality. Prior revascularization had no impact on rates of stroke, death or MACCE.

CONCLUSIONS

Patients with acute STEMI and CS had similar in-hospital and one year mortality, stroke or major adverse cardiac and cerebrovascular events rates irrespective of their prior revascularization status.