Mortality is substantially lower in patients undergoing coronary bypass grafting vs percutaneous coronary intervention with three-vessel coronary disease and cardiogenic shock in the setting of non-ST-elevation myocardial infarction

BackgroundOptimal revascularization strategy in patients with cardiogenic shock and three-vessel coronary disease presenting with non-ST-elevation myocardial infarction (NSTEMI) is not well established. The goal of this study was to use the largest inpatient database to evaluate inpatient mortality of NSTEMI patients with three-vessel disease and cardiogenic shock undergoing coronary bypass surgery (CABG) vs percutaneous coronary intervention (PCI). MethodUsing the Nationwide Inpatient Sample (NIS) database, and ICD-10 coding for NSTEMI, 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 2,805 NSTEMI patients with 3-vessel disease and cardiogenic shock underwent PCI vs.7,585 undergoing CABG. CABG in the setting of NSTEMI-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 (Mortality 25.31% vs 11.22%, P<0.001, OR for CABG patients: 0.37, CI: 0.29-0.48, P<0.001). After adjusting baseline characteristics and comorbidities in multivariate analysis, CABG remained significantly associated with lower mortality (CABG OR 0.41, CI: 0.31-0.54, p<0.001). ConclusionOur data suggests that three-vessel CABG is greatly superior to PCI in NSTEMI patients presenting with cardiogenic shock and three-vessel coronary artery disease.