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J Thorac Cardiovasc Surg 2003;126:1279-1286
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Long-term outcome after coronary artery bypass grafting in cardiogenic shock or cardiopulmonary resuscitation

^a Department of Cardiac Surgery, Gasthuisberg University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
^b Department of Anaesthesiology, Gasthuisberg University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
^c Department of Intensive Care, Gasthuisberg University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium

Read at the Eighty-second Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5-8, 2002.

Received for publication May 2, 2002; revisions received June 14, 2002; revisions received April 25, 2003; accepted for publication June 6, 2003.

^* Address for reprints: Paul Sergeant, MD, PhD, Cardiac Surgery Department, Gasthuisberg University Hospital, Herestraat 44, B-3000 Leuven, Belgium
Paul.Sergeant{at}uz.kuleuven.ac.be

OBJECTIVES: Coronary artery bypass grafting carried out in patients in cardiogenic shock or receiving cardiopulmonary resuscitation is an infrequently performed procedure, disrupting the normal process with a dramatic early risk. These circumstances mandate an analysis of the benefit, including the early identification of the late survivors.

METHODS: A consecutive series of patients undergoing coronary artery bypass grafting while in cardiogenic shock (n = 167) or while receiving cardiopulmonary resuscitation (n = 92) from August 1979 until August 2001 were studied by using time-related and multivariate methodologies and a common-closing-date follow-up methodology. The events leading to the preoperative condition were either a recent catheterization, recent coronary artery bypass grafting, recent percutaneous transluminal coronary angioplasty, an infarction at home, an infarction in the hospital, or an infarction after a recent infarction.

RESULTS: The 1- and 10-year survival was 59% ± 6% and 47% ± 7%, respectively. A normal hazard of late death was observed beyond the protracted early hazard. Multivariate analysis of survival identified an increased risk in the presence of additional comorbidity, treated diabetes, a lower pH at entry into the operating theater, and the presence of triple-vessel disease. The discriminatory power for hospital mortality of the predictive variables was low (receiving operator characteristic range, 0.56-0.69). The 30-day freedom from hospital discharge alive was 33% ± 7%. The 8-day freedom from stroke was 94% ± 3%, and 8-day freedom from mechanical univentricular or biventricular support was 87% ± 5%. The 10-year freedom from cardiosurgical reintervention was 90% ± 6%.

CONCLUSIONS: Coronary artery bypass grafting in cardiogenic shock or during cardiopulmonary resuscitation has an extremely high and protracted periprocedural risk but is balanced by a satisfactory late survival. An early prediction of the hospital survivors is difficult.