Percutaneous coronary intervention and coronary artery bypass grafting in myocardial infarction complicated by cardiogenic shock

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BACKGROUND: Cardiogenic shock (CS) remains the leading cause of poor prognosis in patients with acute myocardial infarction (AMI), sustaining a high mortality rate of 40 to 50% within 30 days. AIMS: In this unique analysis of two national all-comers, real-life registries including patients with AMI complicated by CS, for whom early revascularization was planned, we aimed to compare the effect of percutaneous coronary revascularization (PCI) and coronary artery bypass grafting (CABG) on 30-day and 1-year all-cause mortality. METHODS: The study included consecutive patients with AMI complicated by CS included in the Polish Registry of Acute Coronary Syndromes (PL-ACS) and the Polish National Registry of Cardiac Surgical Procedures (KROK), treated with PCI and CABG, respectively. A layered analysis and Kaplan-Meier curves were used in the propensity score matched (PSM) groups. RESULTS: Between 2006 and 2022, a total of 1970 patients with AMI complicated by CS, with known coronary anatomy were included in PL-ACS and KROK registries. 1376 (69.8%) had PCI and 594 (30.2%) had CABG. Following a 1:1 PSM, a total of 822 patients were finally included in the analysis. The mortality rates were 48.2% in the PCI group compared with 38.6% in the CABG group at 30 days (P <0.001) and 53.5% compared with 41.1%, respectively, at 1 year (P <0.001). CONCLUSIONS: Among patients with AMI affected by CS, those qualified to be treated with CABG had a higher survival rate at 30 days and one year as compared to those treated with PCI.