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Percutaneous coronary intervention or coronary artery bypass surgery for cardiogenic shock and multivessel coronary artery disease?
Am Heart J. 2010 Jan; 159(1):141-7.AH

Abstract

BACKGROUND

Despite advances in treatment of cardiogenic shock (CS), the incidence of this serious complication of acute ST-elevation myocardial infarction (STEMI) has stayed relatively constant, and rates of mortality, although somewhat improved in recent decades, remain dauntingly high. Although both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used in patients with CS with multivessel coronary disease, the optimal revascularization strategy in this setting remains unknown.

METHODS

We conducted a literature search and review of English language publications on CS in multiple online medical databases. Studies were included if they were (1) randomized controlled trials or observational cohort studies, (2) single-center or multicenter reports, (3) prospective or retrospective studies, and (4) contained information on PCI and CABG. Non-English language studies were excluded.

RESULTS

Our search retrieved no published findings from randomized clinical trials, and only 4 observational reports evaluating PCI versus CABG. Our review of the limited available data suggests similar mortality rates with CABG and PCI in patients with STEMI and multivessel coronary disease complicated by CS.

CONCLUSIONS

Limited data from observational studies in patients with CS and multivessel disease suggest that CABG should be considered a complementary reperfusion strategy to PCI and may be preferred, especially when complete revascularization with PCI is not possible. Our data highlight the need for large randomized trials to further evaluate the relative benefit of PCI versus CABG in patients with multivessel coronary disease and CS using contemporary surgical and percutaneous techniques.

Authors+Show Affiliations

The Duke University Medical Center and Duke Clinical Research Institute, Durham, NC 27715, USA. mehta007@dcri.duke.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Review

Language

eng

PubMed ID

20102880

Citation

Mehta, Rajendra H., et al. "Percutaneous Coronary Intervention or Coronary Artery Bypass Surgery for Cardiogenic Shock and Multivessel Coronary Artery Disease?" American Heart Journal, vol. 159, no. 1, 2010, pp. 141-7.
Mehta RH, Lopes RD, Ballotta A, et al. Percutaneous coronary intervention or coronary artery bypass surgery for cardiogenic shock and multivessel coronary artery disease? Am Heart J. 2010;159(1):141-7.
Mehta, R. H., Lopes, R. D., Ballotta, A., Frigiola, A., Sketch, M. H., Bossone, E., & Bates, E. R. (2010). Percutaneous coronary intervention or coronary artery bypass surgery for cardiogenic shock and multivessel coronary artery disease? American Heart Journal, 159(1), 141-7. https://doi.org/10.1016/j.ahj.2009.10.035
Mehta RH, et al. Percutaneous Coronary Intervention or Coronary Artery Bypass Surgery for Cardiogenic Shock and Multivessel Coronary Artery Disease. Am Heart J. 2010;159(1):141-7. PubMed PMID: 20102880.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Percutaneous coronary intervention or coronary artery bypass surgery for cardiogenic shock and multivessel coronary artery disease? AU - Mehta,Rajendra H, AU - Lopes,Renato D, AU - Ballotta,Andrea, AU - Frigiola,Alessandro, AU - Sketch,Michael H,Jr AU - Bossone,Eduardo, AU - Bates,Eric R, PY - 2009/10/30/received PY - 2009/10/30/accepted PY - 2010/1/28/entrez PY - 2010/1/28/pubmed PY - 2010/3/3/medline SP - 141 EP - 7 JF - American heart journal JO - Am Heart J VL - 159 IS - 1 N2 - BACKGROUND: Despite advances in treatment of cardiogenic shock (CS), the incidence of this serious complication of acute ST-elevation myocardial infarction (STEMI) has stayed relatively constant, and rates of mortality, although somewhat improved in recent decades, remain dauntingly high. Although both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are used in patients with CS with multivessel coronary disease, the optimal revascularization strategy in this setting remains unknown. METHODS: We conducted a literature search and review of English language publications on CS in multiple online medical databases. Studies were included if they were (1) randomized controlled trials or observational cohort studies, (2) single-center or multicenter reports, (3) prospective or retrospective studies, and (4) contained information on PCI and CABG. Non-English language studies were excluded. RESULTS: Our search retrieved no published findings from randomized clinical trials, and only 4 observational reports evaluating PCI versus CABG. Our review of the limited available data suggests similar mortality rates with CABG and PCI in patients with STEMI and multivessel coronary disease complicated by CS. CONCLUSIONS: Limited data from observational studies in patients with CS and multivessel disease suggest that CABG should be considered a complementary reperfusion strategy to PCI and may be preferred, especially when complete revascularization with PCI is not possible. Our data highlight the need for large randomized trials to further evaluate the relative benefit of PCI versus CABG in patients with multivessel coronary disease and CS using contemporary surgical and percutaneous techniques. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/20102880/Percutaneous_coronary_intervention_or_coronary_artery_bypass_surgery_for_cardiogenic_shock_and_multivessel_coronary_artery_disease L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(09)00834-5 DB - PRIME DP - Unbound Medicine ER -