Coronary bypass grafting in patients with three-vessel coronary artery disease in the setting of ST-elevation myocardial infarction and Cardiogenic shock is associated with substantially lower mortality compared to undergoing percutaneous coronary intervention

BackgroundThe shock trial was the first small, randomized trial revealing revascularization of patients presenting with ST-elevation myocardial infarction (STEMI) with coronary bypass surgery (CABG) have a better survival rate than percutaneous coronary intervention (PCI) The goal of this study was to use the largest inpatients database, to evaluate inpatients mortality of STEMI patients with three-vessel disease and cardiogenic shock undergoing CABG vs PCI. MethodeUsing the Nationwide Inpatient Sample (NIS) database, and ICD-10 coding for cardiogenic shock, three-vessel CABG, and three-vessel PCI, we evaluate total inpatient mortality comparing three-vessel CABG vs three-vessel PCI in adults over age 18 years. ResultsA total of 3,565 STEMI patients with 3 vessel disease and cardiogenic shock underwent PCI vs.3,950 undergoing CABG. CABG in the setting of STEMI-related cardiogenic shock and three-vessel CAD is associated with much lower mortality compared to three-vessel PCI despite multivariate adjustment. Mortality was more than twice in patients undergoing PCI vs CABG (68.27% vs 31.73%, P<0.001, OR for CABG patients: 0.32, CI: 0.25-0.42, P<0.001). After adjusting baseline characteristics and comorbidities in multivariate analysis, CABG remained significantly associated with lower mortality (CABG OR 0.34, CI:0.26-0.44, p<0.001). ConclusionOur data confirms the finding of the Schock trial that three-vessel CABG is greatly superior to PCI in STEMI patients presenting with cardiogenic shock and three-vessel coronary artery disease. Condensed AbstractUsing the Nationwide Inpatient Sample (NIS) database, and ICD-10 coding for cardiogenic shock, three-vessel CABG, and three-vessel PCI, we evaluate total inpatient mortality comparing three-vessel CABG vs three-vessel PCI in adults over age 18 years. A total of 3,565 STEMI patients with 3 vessel disease and cardiogenic shock underwent PCI vs.3,950 undergoing CABG. CABG in the setting of STEMI-related cardiogenic shock and three-vessel CAD is associated with much lower mortality compared to three-vessel PCI despite multivariate adjustment. After adjusting baseline characteristics and comorbidities in multivariate analysis, CABG remained significantly associated with lower mortality (CABG OR 0.34, CI:0.26-0.44, p<0.001).