Temporal Trends in Predictors of Early and Late Mortality After Emergency Coronary Artery Bypass Grafting for Cardiogenic Shock Complicating Acute Myocardial Infarction
Authors' conclusion
Emergency coronary artery bypass grafting in patients with acute myocardial infarction complicated by cardiogenic shock is associated with a high in-hospital mortality, which showed a significant decline with time. Hospital survivors have good long-term outcomes, which demonstrate the beneficial effect of surgical revascularization. Preoperative serum lactate >4 mmol/L is a strong predictor of both early and late mortality.
Study context
- Population
- Patients undergoing emergency CABG for cardiogenic shock complicating acute MI, January 2000–June 2014
- Participants
- 508 patients
- Exposure
- Time cohorts 2000–2004 vs 2005–2009 vs 2010–2014
- 2000 to 2004n = 204reference
- 2005 to 2009n = 166
- 2010 to 2014n = 138
- Outcome
- In-hospital mortality (predictors per time cohort)
Main finding
As reported in the abstract
In-hospital mortality
Odds ratio (95% CI)P value
Serum lactate >4 mmol/L
4.78(2.88–7.95)
P < 0.0001ST-segment-elevation myocardial infarction
2.10(1.36–3.26)
P = 0.001Age >75 years
2.01(1.06–3.85)
P = 0.03Left ventricular ejection fraction <30%
1.83(1.15–2.91)
P = 0.01- Overall in-hospital mortality
- 33.7%
- In-hospital mortality declined across the 3 time cohorts (P=0.02)
- 42.2% to 30.7% to 24.6%
Observational data: associations, not effects.
Further findings
| Outcome | OR | P value |
|---|---|---|
| Predictors of late mortalitySerum lactate >4 mmol/L | 2.2 | P < 0.0001 |
| Predictors of late mortalityIncremental age | 1.05 | P < 0.0001 |
| Predictors of late mortalityNew York Heart Association class IV | 1.33 | P = 0.02 |
| Predictors of late mortalityDiabetes mellitus | 1.39 | P = 0.005 |
| Predictors of late mortalityPreoperative inotropic support | 2.61 | P = 0.001 |
| Predictors of late mortalityExtracorporeal membrane oxygenation · preoperative support | 1.68 | P = 0.05 |
Cumulative survival · 5 and 10 years
- All patients, 5 years
- 42.6±2.0%
- All patients, 10 years
- 33.4±2.0%
- Hospital survivors, 5 years
- 64.3±3.0%
- Hospital survivors, 10 years
- 49.8±3.0%
Original publication
Temporal Trends in Predictors of Early and Late Mortality After Emergency Coronary Artery Bypass Grafting for Cardiogenic Shock Complicating Acute Myocardial Infarction. Circulation. Published 25 October 2016. doi:10.
Summarised from the published abstract; every number is checked against it