Determinants of successful surgical revascularization for failed angioplasty in patients with acute myocardial infarction and cardiogenic shock.
OBJECTIVE
Previous studies have reported encouraging results with percutaneous transluminal coronary angioplasty (PTCA) in patients with acute myocardial infarction (AMI) and cardiogenic shock (CS). However, PTCA fails in many patients and the mortality rate associated with the procedure is very high. This study sought to assess the determinants of successful coronary artery bypass grafting (CABG) in patients with AMI, CS and failed PTCA.


METHODS
From April 1997 to May 2001, 33 patients with a mean age of 62.9 +/- 10.5 years underwent CABG for AMI, CS and failed PTCA. PTCA failed or was not attempted because of primary failure in 13 patients, reocclusion in three, no-reflow in one, and multivessel disease in 18. Patients were initially stabilized with inotropic infusion and mechanical circulatory support. Before June 2000, patients underwent conventional CABG, while after June 2000, patients underwent beating heart CABG. Risk factor analysis was performed using retrospective chart review.


RESULTS
The overall in-hospital mortality rate was 30.3%-33.3% in 24 patients who underwent conventional CABG and 22.2% in nine patients who underwent beating heart CABG. Risk factors for death were unstable hemodynamics (p < 0.001), non-right coronary artery as the infarct-related artery (IRA) (p = 0.012), high inotropic dose (p = 0.013), intubation (p = 0.021), cardiopulmonary resuscitation (p = 0.021), and early bypass (p = 0.050).


CONCLUSIONS
CABG was associated with a high in-hospital mortality rate in patients with AMI, CS and failed PTCA. Patients with unstable hemodynamics and high inotropic dose before surgery had the worst survival rate.
Hsu
Ron-Bin
RB
Department of Surgery, National Taiwan University Hospital, Far Eastern Memorial Hospital, Taipei, Taiwan.
Chen
Robert J
RJ
Wang
Shoei-Shen
SS
Chu
Shu-Hsun
SH
D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass / Q000379:methods* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000601:surgery*; D017211:Treatment Failure; D016896:Treatment Outcome