Background: Coronary artery bypass graft surgery (CABG) is recommended for revascularization of coronary artery in high risk patients such as left main involvement, multi-vessel coronary artery disease, failed percutaneous coronary intervention (PCI) or proximal left anterior descending coronary artery (LAD) involvement with impaired systolic dysfunction. Little is known about the risk factors of in hospital mortality in acute myocardial infarction (AMI) patients who undergone CABG. The aim of the present study was to evaluate the predictors of in hospital mortality in AMI patients undergone CABG.
Methods and Results: 192 AMI patients (140 males, 64.8±10.5 year-old) undergone CABG were enrolled from Jan 2008 to May 2009 in KORMI. These patients were divided to two groups according to survival in hospital. In hospital mortality was 10.6% (20 patients). Age (70.9±6.9 vs. 63.9±10.6, p=0.006), female gender (19.2% vs. 7.4%, p=0.018), smoking history (35.0% vs. 61.1%, p=0.025), increased heart rate (91.9±30.9 vs. 81.1±21.1, p=0.04) is more associated with hospital mortality. Diagnosis of STEMI, LM main involvement, failed PCI, PCI of infarction related artery, higher Killip class (III-IV) were not statistical different in between two groups. In laboratory finding, hs-CRP (39.1±87.1 vs. 11.46±36.0, p=0.022) and log proBNP (3.9±0.5 vs. 3.0±0.7, p<0.001) were increased in death group. Cardiogenic shock (45% vs 3.0%, p<0.001), use of IABP (45% vs 6.5%, p<0.001), intubation (45% vs. 4.2%, p<0.001) DC cardioversion (20% vs 1.2%, p<0.001) and use of temporary pacemarker (15% vs 3%, p=0.04) were more associated with hospital mortality. There is no statistical difference in infarct related artery, number of involved vessel, lesion type and pre-TIMI flow in angiographic finding between two groups. In Multi-variate logistic regression analysis, cardiogenic shock was independent predictor (OR: 18.9 95% CI : 4.713-75.792, p<0.001) of in-hospital mortality in AMI patients undergone CABG.
Conclusions: Infarct related artery, number of involved vessel, lesion type, pre TIMI flow, failed PCI does not affect in-hospital mortality. But, cardiogenic shock was the predictor of in-hospital mortality in AMI patients undergone CABG.
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