title: Long-term outcome after coronary artery bypass grafting in cardiogenic shock or cardiopulmonary resuscitation.
abstract: OBJECTIVE
  Coronary artery bypass grafting carried out in patients in cardiogenic shock or receiving cardiopulmonary resuscitation is an infrequently performed procedure, disrupting the normal process with a dramatic early risk. These circumstances mandate an analysis of the benefit, including the early identification of the late survivors.
  
  
  METHODS
  A consecutive series of patients undergoing coronary artery bypass grafting while in cardiogenic shock (n = 167) or while receiving cardiopulmonary resuscitation (n = 92) from August 1979 until August 2001 were studied by using time-related and multivariate methodologies and a common-closing-date follow-up methodology. The events leading to the preoperative condition were either a recent catheterization, recent coronary artery bypass grafting, recent percutaneous transluminal coronary angioplasty, an infarction at home, an infarction in the hospital, or an infarction after a recent infarction.
  
  
  RESULTS
  The 1- and 10-year survival was 59% +/- 6% and 47% +/- 7%, respectively. A normal hazard of late death was observed beyond the protracted early hazard. Multivariate analysis of survival identified an increased risk in the presence of additional comorbidity, treated diabetes, a lower pH at entry into the operating theater, and the presence of triple-vessel disease. The discriminatory power for hospital mortality of the predictive variables was low (receiving operator characteristic range, 0.56-0.69). The 30-day freedom from hospital discharge alive was 33% +/- 7%. The 8-day freedom from stroke was 94% +/- 3%, and 8-day freedom from mechanical univentricular or biventricular support was 87% +/- 5%. The 10-year freedom from cardiosurgical reintervention was 90% +/- 6%.
  
  
  CONCLUSIONS
  Coronary artery bypass grafting in cardiogenic shock or during cardiopulmonary resuscitation has an extremely high and protracted periprocedural risk but is balanced by a satisfactory late survival. An early prediction of the hospital survivors is difficult.
authors.affiliation: Department of Cardiac Surgery, Gasthuisberg University Hospital, Katholieke Universiteit Leuven, Belgium. Paul.Sergeant@uz.kuleuven.ac.be
authors.forename: Paul
authors.initials: P
authors.lastname: Sergeant
authors.forename: Bart
authors.initials: B
authors.lastname: Meyns
authors.forename: Patrick
authors.initials: P
authors.lastname: Wouters
authors.forename: Roland
authors.initials: R
authors.lastname: Demeyere
authors.forename: Peter
authors.initials: P
authors.lastname: Lauwers
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000401:mortality*; D002423:Cause of Death; D015331:Cohort Studies; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012770:Shock, Cardiogenic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016019:Survival Analysis