Abstract 17855: Prognostic Impact of Coronary Revascularization in Acute Coronary Syndrome Patients With Cardiogenic Shock

Abstract

Background: Randomized trials have shown that coronary revascularization benefits patients with acute coronary syndrome (ACS). Furthermore, recent studies reported that revascularization could improve the outcome even in high-risk patients. We investigated the prognostic impact of revascularization and the factors that abandon the invasive strategy in patients with ACS complicated with cardiogenic shock. Methods and results: The Japanese Circulation Society Cardiovascular Shock registry (JCS-Shock registry) was a prospective, observational, multi-center, cohort study. Between May, 2012 and June, 2014, a total of 980 patients with cardiovascular shock were enrolled from 82 centers in Japan. We assessed the prognostic impact of coronary revascularization in ACS patients in JCS-Shock registry. The primary endpoint was all cause mortality at 30 days after administration. Among 495 subjects with ACS (ST-segment elevation acute myocardial infarction (STEMI) 408, Non-ST-segment elevation ACS (NSTEACS) 87), emergent coronary angiography was carried out in 448 (90.9%) subjects and any revascularization (percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG)) was performed in 411 (83.0%) subjects. Thirty-day mortality in subjects treated with PCI and/or CABG (Revasc group) was 29.8% and neither PCI nor CABG (Non-Revasc group) was 51.2% (n=84, 17.0%) (P=0.0015 by Chi-square test), suggesting a beneficial effect of revascularization. Baseline characteristics of subgroups in Revasc or Non-Revasc were significantly different in age (71.0 vs. 76.5, P<0.0037), female gender (23.2% vs. 40.5%, P=0.0016), previous PCI (66.7% vs. 39.1%, P<0.0276), STEACS (86.8% vs. 60.7%, P<0.0001). Conclusions: In the JCS Shock registry that observed contemporary emergency cardiovascular care in Japan, 30-day mortality of ACS complicated with cardiogenic shock was lower in patients underwent coronary revascularization compared with patients without any revascularization. Revascularization was less performed in elderly, female, patients without previous PCI and NSTEACS patients, associated with unfavorable outcomes. We may reconsider the therapeutic strategy to benefit patients by coronary revascularization.