Abstract 2296: Surgical Intervention Provides Better Survival in the Patients with Acute Coronary Syndrome and ST-Segment Elevation Myocardial Infarction Experiencing Cardiogenic Shock and Requiring Intra-Aortic Balloon Counterpulsation after Percutaneous Coronary Intervention
Although studies have consistently suggested that emergent revascularization reduces mortality, it remains a crucial clinical question as to find the best treatment strategy in the patients who experience acute coronary syndrome (ACS) and ST-segment elevation myocardial infarction (STEMI) sustaining in cardiogenic shock. Patients who experienced cardiogenic shock due to ACS and STEMI who required hemodynamic support with intra-aortic balloon counterpulsation (IABP) were retrospectively retrieved from the clinical information system in a tertiary medical center in Taiwan. A propensity-score based matching process was applied to find equalized groups with documented involvement of more than two coronary vessels who received percutaneous coronary intervention (PCI) only and who underwent subsequent coronary bypass grafting surgery (CABG) after PCI. A logistic regression model was used to find the factors associated with 30-day mortality. During the period between 2002 and 2004, a total of 247 patients were found to experience cardiogenic shock after PCI requiring IABP due to ACS and STEMI. The propensity-score based method identified 44 patients in the PCI only group (35 men, 65±2 years and 9 women, 75±4 years) and the other 44 patients in the PCI+CABG group (31 men, 67±2 years and 13 women, 71±2 years) who had comparable baseline characteristics in sex, age, diabetes mellitus, hypertension, Killip classification, underlying etiology, severity of congestive heart failure, peak troponin I level, number of coronary vessel involvement, and the use of extra-corporeal membrane oxygenation (ECMO). The 30-day mortality, 20.5% in the PCI+CABG group and 40.9% in the PCI only group, was negatively associated with CABG (odds ratio: 0.30, 95% CI: 0.10~0.88, p = 0.03), and positively associated with increased age (OR: 1.06 for each year, 95% CI: 1.01~1.12, p = 0.01) and a need to use ECMO (OR: 9.64, 95% CI: 2.19~42.4, p < 0.001). This study has demonstrated the survival benefit of surgical intervention in the high-risk patients with ACS or STEMI who experienced cardiogenic shock and required IABP after PCI.