Abstract P170: Risk Analysis of Patients Suffering Acute Myocardial Infarction Complicated by Cardiogenic Shock Receiving Emergency Coronary Artery Bypass Grafting
Background: Cardiogenic shock (CS) is the most common cause of death in patients hospitalized with acute myocardial infarction (AMI). Aim of this study was to evaluate risk factors for in-hospital and follow up mortality of patients suffering of AMI complicated by CS undergoing coronary artery bypass graft surgery (CABG).
Methods: Between 01/2000 and 12/2007 302 Patients (68.74 years; 76.2% male; 42.5% STEMI; 57.5% NSTEMI) underwent CABG surgery. 40.7% had CS at hospital admission, 59.3% experienced CS during hospital stay. We evaluated 44 preoperative, 18 intraoperative and 28 postoperative risk factors for mortality by uni- and multivariate logistic regression models. Cumulative survival was estimated by Kaplan-Meier analysis. Mean follow-up was 2.5 years (0.0–7.4 years).
Results: Hospital mortality was 37.1% (112 pts). Significant univariate preoperative risk factors for hospital mortality were preexisting renal dysfunction (Odds ratio (OR) 2.3, p=0.004), EF <30% (OR 1.7, p=0.032), logistic EuroSCORE>20 (OR 19.2, p=0.004), STEMI (OR 1.83, p=0,013), preop lactate level >4mM (OR 3.58, p<0.001) while renal dysfunction, EuroSCORE >20 and lactate level >4mM were also significant independent risk factors during multivariate analysis. Intraoperatively hospital mortality was furthermore significantly reduced in case of CPB time >100 min (OR 1,77, p=0.018), delayed IABP (OR 1.88, p=0.013) and ECMO support (OR 4.15, p<0.001), while LIMA use was protective (OR 0.29, p<0.001). During postoperative course CK-MB fraction >120U/l on POD1 (OR 3.88, p<0.001), high blood loss (OR 2.04, p=0,007) and all cardiovascular and cardiac events as well as acute renal failure (OR 5.92, p<0.001) were risk factors for hospital outcome. 57 Patients (18.87%) died during follow-up. Cumulative survival was 50.7±2.9% after 1 year, 46.1±3.0% after 3 years and 38.2±3.3% after 5 years. Mean survival time was 3.2 years.
Conclusion Mortality of emergency CABG in AMI complicated by CS is strongly associated on preoperative patient condition and cardiac and extracardiac morbidity. However, good long-term outcome of hospital survivers demonstrate the high benefit of emergency surgical revascularization in CS patients with otherwise bad prognosis.