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Outcomes after coronary artery bypass grafting in patients with myocardial infarction, cardiogenic shock and unresponsive neurological state: analysis of the Society of Thoracic Surgeons Database.

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Cox, ML; Gulack, BC; Thibault, DP; He, X; Williams, ML; Thourani, VH; Jacobs, JP; Brennan, JM; Daneshmand, MA; Acharya, D
Published in: Eur J Cardiothorac Surg
October 1, 2018

OBJECTIVES: Previous studies have demonstrated a 20% mortality rate among patients undergoing isolated coronary artery bypass grafting (CABG) for cardiogenic shock. However, outcomes following CABG for cardiogenic shock in patients who are neurologically unresponsive preoperatively are unknown. METHODS: Utilizing the Society of Thoracic Surgeons Adult Cardiac Surgery Database between July 2011 and December 2013, patients undergoing urgent or emergent CABG within 7 days of an acute myocardial infarction complicated by cardiogenic shock were identified. Patients were stratified on the basis of whether they had a non-medically induced unresponsive state within 24 h of surgery. RESULTS: Of the 5259 patients with acute myocardial infarction complicated by cardiogenic shock who underwent CABG during the study period, 243 (4.62%) patients had an unresponsive preoperative neurological state. The unresponsive cohort had a higher 30-day operative mortality than the responsive cohort (33.74% vs 16.91%, P < 0.001). Unresponsive neurological state was associated with increased odds for mortality (adjusted odds ratio 1.81, 95% confidence interval 1.37-2.4; P < 0.001), postoperative stroke (adjusted odds ratio 2.17, 95% confidence interval 1.27-3.73; P = 0.0048) and encephalopathy (adjusted odds ratio 2.08, 95% confidence interval 1.44-3.01; P < 0.001). Among survivors in the unresponsive cohort, 78 (46.15%) were discharged home and 62 (36.69%) were discharged to extended care facilities. CONCLUSIONS: Although cardiac surgery in unresponsive patients in the setting of acute myocardial infarction complicated by cardiogenic shock is associated with considerable neurological disability and mortality, the majority survive to discharge. These findings may help guide patient and family discussions regarding goals of care.

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Published In

Eur J Cardiothorac Surg

DOI

EISSN

1873-734X

Publication Date

October 1, 2018

Volume

54

Issue

4

Start / End Page

710 / 716

Location

Germany

Related Subject Headings

  • United States
  • Treatment Outcome
  • Thoracic Surgery
  • Survival Rate
  • Societies, Medical
  • Shock, Cardiogenic
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Registries
 

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Cox, M. L., Gulack, B. C., Thibault, D. P., He, X., Williams, M. L., Thourani, V. H., … Acharya, D. (2018). Outcomes after coronary artery bypass grafting in patients with myocardial infarction, cardiogenic shock and unresponsive neurological state: analysis of the Society of Thoracic Surgeons Database. In Eur J Cardiothorac Surg (Vol. 54, pp. 710–716). Germany. https://doi.org/10.1093/ejcts/ezy114
Cox, Morgan L., Brian C. Gulack, Dylan P. Thibault, Xia He, Matthew L. Williams, Vinod H. Thourani, Jeffery P. Jacobs, J Matthew Brennan, Mani A. Daneshmand, and Deepak Acharya. “Outcomes after coronary artery bypass grafting in patients with myocardial infarction, cardiogenic shock and unresponsive neurological state: analysis of the Society of Thoracic Surgeons Database.” In Eur J Cardiothorac Surg, 54:710–16, 2018. https://doi.org/10.1093/ejcts/ezy114.
Cox ML, Gulack BC, Thibault DP, He X, Williams ML, Thourani VH, Jacobs JP, Brennan JM, Daneshmand MA, Acharya D. Outcomes after coronary artery bypass grafting in patients with myocardial infarction, cardiogenic shock and unresponsive neurological state: analysis of the Society of Thoracic Surgeons Database. Eur J Cardiothorac Surg. 2018. p. 710–716.
Journal cover image

Published In

Eur J Cardiothorac Surg

DOI

EISSN

1873-734X

Publication Date

October 1, 2018

Volume

54

Issue

4

Start / End Page

710 / 716

Location

Germany

Related Subject Headings

  • United States
  • Treatment Outcome
  • Thoracic Surgery
  • Survival Rate
  • Societies, Medical
  • Shock, Cardiogenic
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Registries