Abstract 18046: Emergency Coronary Artery Bypass Grafting for Cardiogenic Shock Complicating Acute Myocardial Infarction is Associated With Satisfactory Long-term Outcomes in Hospital Survivors

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Introduction: Cardiogenic shock (CS), which is one of the most dreadful complications following acute myocardial infarction (AMI), is an indication for emergent coronary artery bypass graft surgery (CABG) in patients not amenable for percutaneous coronary intervention. Our study aimed to identify risk factors for 30-day and long-term mortality in patients presenting with AMI complicated by CS requiring emergency CABG. Methods: Preoperative characteristics, operative parameters, and postoperative outcomes were prospectively collected for 508 patients undergoing CABG for CS complicating AMI (ST-elevation MI [STEMI]:42.9%;non-STEMI:57.1%) in our database between January 2000 and June 2014. Predictors of 30-day and long-term mortality were identified by logistic and Cox regression analyses, respectively. Results: Mean age was 69±10 years. 78.3% of patients had 3-vessel and 47% left main disease. Almost 50% of patients had left ventricular function <30% with 29.6%, 37.9%, 46.7% and 9.8% requiring preoperative resuscitation, ventilator, intra-aortic balloon pump and extracorporeal membrane oxygenation support (ECMO), respectively. 30-day mortality was 31.9% and was independently predicted by peripheral vascular disease [PVD] (odds ratio [OR]:1.8; 95% confidence interval [CI]:1.1-2.9;p=0.02), STEMI (OR:1.9;95%CI:1.2-2.8;p=0.004), lactate levels >4mmol/l (OR:3.3;95%CI:1.7-6.5;p<0.0001) and ECMO support (OR:5.0;95%CI:2.6-9.9;p<0.0001). Cumulative survival was 51% at 1 year, 44% at 3 years and 33% at 5 years and correspondingly improved to 74%, 64% and 48%, when 30-day mortality was excluded from the analysis. Incremental age (OR:1.04,p<0.0001), STEMI (OR:1.3,p=0.02), PVD (OR:1.4,p=0.03), diabetes (OR:1.5,p=0.001), lactate levels >4mmol/l (OR:2.3,p<0.0001) and high preoperative inotropic (OR:1.3,p=0.02), and ECMO support (OR:3.3,p<0.0001) predicted late mortality. Conclusion: Emergency CABG in patients with AMI complicated by CS was associated with high 30-day mortality, which was independently predicted by severe preoperative hemodynamic instability and presence of STEMI. Satisfactory long-term survival is observed in patients who survived the operation, demonstrating the benefit of emergency CABG.