Universität zu Köln

Liakopoulos, Oliver J., Schlachtenberger, G., Wendt, Daniel, Choi, Yeong-Hoon, Slottosch, Ingo, Welp, Henryk, Schiller, Wolfgang ORCID: 0000-0003-2589-8016, Martens, Sven, Welz, Armin, Neuhaeuser, Markus, Jakob, Heinz, Wahlers, Thorsten and Thielmann, Matthias (2019). Early Clinical Outcomes of Surgical Myocardial Revascularization for Acute Coronary Syndromes Complicated by Cardiogenic Shock: A Report From the North-Rhine-Westphalia Surgical Myocardial Infarction Registry. J. Am. Heart Assoc., 8 (10). HOBOKEN: WILEY. ISSN 2047-9980

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Abstract

Background-Coronary artery bypass grafting for acute coronary syndrome complicated by cardiogenic shock (CS) is associated with a high mortality. This registry study aimed to distinguish between early surgical outcomes of CS patients with non-ST-segment-elevation myocardial infarction (NSTEMI) and ST-segment-elevation myocardial infarction (STEMI). Methods and Results-Patients with NSTEMI (n=1218) or STEMI (n=618) referred for coronary artery bypass grafting were enrolled in a prospective multicenter registry between 2010 and 2017. CS was present in 227 NSTEMI (18.6%) and 243 STEMI patients (39.3%). Key clinical end points were in-hospital mortality (IHM) and major adverse cardiocerebral events (MACCEs). Predictors for IHM and MACCEs were identified using multivariable logistic regression analysis. STEMI patients with CS were younger, had a lower prevalence of diabetes mellitus and multivessel disease, and exhibited higher myocardial injury (troponin 9 +/- 17 versus 3 +/- 6 ng/mL) before surgery compared with patients with NSTEMI (P<0.05). Emergency coronary artery bypass grafting was performed more often in STEMI (58%) versus NSTEMI (40%; P=0.002). On-pump surgery with cardioplegia was the preferred surgical technique in CS. IHM and MACCE rates were 24% and 49% in STEMI patients with CS and were higher compared with NSTEMI (IHM 15% versus MACCE 34%; P<0.001). Predictors for IHM and MACCE in CS were a reduced ejection fraction and a higher European System for Cardiac Operative Risk Evaluation score. Conclusions-Surgical revascularization in NSTEMI and STEMI patients with CS is associated with a substantial but not prohibitive IHM and MACCE rate. Worse early outcomes were found for patients with STEMI complicated by CS compared with NSTEMI patients.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Liakopoulos, Oliver J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Schlachtenberger, G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wendt, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Choi, Yeong-Hoon UNSPECIFIED UNSPECIFIED UNSPECIFIED Slottosch, Ingo UNSPECIFIED UNSPECIFIED UNSPECIFIED Welp, Henryk UNSPECIFIED UNSPECIFIED UNSPECIFIED Schiller, Wolfgang UNSPECIFIED orcid.org/0000-0003-2589-8016 UNSPECIFIED Martens, Sven UNSPECIFIED UNSPECIFIED UNSPECIFIED Welz, Armin UNSPECIFIED UNSPECIFIED UNSPECIFIED Neuhaeuser, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Jakob, Heinz UNSPECIFIED UNSPECIFIED UNSPECIFIED Wahlers, Thorsten UNSPECIFIED UNSPECIFIED UNSPECIFIED Thielmann, Matthias UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-147973
DOI:	10.1161/JAHA.119.012049
Journal or Publication Title:	J. Am. Heart Assoc.
Volume:	8
Number:	10
Date:	2019
Publisher:	WILEY
Place of Publication:	HOBOKEN
ISSN:	2047-9980
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language ARTERY-BYPASS SURGERY; ST-SEGMENT-ELEVATION; GRAFT-SURGERY; CARDIOVASCULAR-SURGERY; EMERGENCY; INTERVENTION; HEART; MANAGEMENT; MORTALITY; SOCIETY Multiple languages Cardiac & Cardiovascular Systems Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/14797