Thorac Cardiovasc Surg 2022; 70(S 01): S1-S61
DOI: 10.1055/s-0042-1742882
Oral and Short Presentations
Monday, February 21
Risk Management in Coronary Artery Disease

Surgical Myocardial Revascularization in Patients with Acute Myocardial Infarction and Cardiogenic Shock: Data from the GERMIN-SURG Registry

P. Grieshaber
1   Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Deutschland
,
M. Hamiko
2   Sigmund-Freud-Str 25, Bonn, Deutschland
,
M. Albert
3   Herz- und Gefäßchirurgie, Robert-Bosch-Hospital, Stuttgart, Deutschland
,
J. Ginsberg
4   Department of Anesthesiology, Luzerner Kantonsspital, Luzern, Switzerland
,
T. Krüger
5   Hoppe-Seyler-Straße 3, Tübingen, Deutschland
,
F. Brenck
6   Department of Anesthesiology, Universitätsklinikum Gießen, Gießen, Deutschland
,
A. Böning
7   Rudolf-Buchheim-Str. 7, Gießen, Deutschland
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Background: Percutaneous coronary intervention (PCI) is the first-line therapy for patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS). However, mortality rates remain as high as 40 to 60%. Coronary artery bypass grafting (CABG) is usually considered if the coronary anatomy or other reasons make the patient non-eligible for PCI. Some retrospective data indicate that CABG might result in better outcomes compared with PCI. This study analyzes the outcomes of CABG for AMI-CS in a prospective multicenter registry.

Method: All patients who underwent emergency CABG for AMI-CS (instable hemodynamics requiring vasopressors or inotropes to maintain a systolic blood pressure of >90 mm Hg for >30 minutes with either lactatemia, oliguria or clinical signs of malperfusion) who were included in the GERMIN-SURG registry at four German cardiac surgery centers between 07/2017 and 12/2019 were included. 30-days mortality and other outcome parameters were analyzed.

Results: Of 623 patients included in the registry, 33 patients (5.3%; 67% male, median age 65 years, serum lactate 4.5 ± 7.4 mmol/L) presented with AMI-CS. The decision toward CABG was made based on the complexity of coronary anatomy in 68% of patients or after failed PCI in 32% of patients. 8 patients (24%) had an intraaortic balloon pump (IABP) inserted preoperatively, 2 patients (6%) were taken on extracorporeal life support (ECLS). 97% of CABG were conducted with cardiopulmonary bypass, thereof 13% without cardioplegic arrest on the beating heart. A median of 3 (IQR 2–4) distal anastomoses were constructed. 14 of 23 patients (61%) who had no mechanical circulatory support (MCS) preoperatively needed MCS at the end of the operation (IABP 21%, ECLS 29%, ECLS + Impella 8.3%). In the postoperative course, 5 patients (15%) underwent re-exploration due to bleeding, 6 patients (18%) needed hemodialysis, 9 patients (27%) underwent tracheostomy, and 3 patients (9.1%) had a neurological event, respectively. Overall 30-days mortality was 30%. Patients with preoperative IABP had a mortality of 12.5%, both patients who needed ECLS preoperatively died. Patients who received an IABP intraoperatively had a lower mortality (20%) compared with those who needed ECLS (57%) or ECLS + Impella (100%; p = 0.034).

Conclusion: In patients with AMI-CS, CABG can be performed with a high burden of postoperative care but considerably lower mortality rates compared with the rates seen in patients treated with PCI. The IABP is still a frequently used option for perioperative MCS in those patients. The choice and timing of perioperative MCS might play a prognostic role in this setting.



Publication History

Article published online:
03 February 2022

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