Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock: Results from the should we emergently revascularize occluded coronaries for cardiogenic shock (SHOCK) trial

Harvey D. White, Susan F. Assmann, Timothy A. Sanborn, Alice K. Jacobs, John G. Webb, Lynn A. Sleeper, Cheuk Kit Wong, James T. Stewart, Philip E G Aylward, Shing Chiu Wong, Judith S. Hochman

Research output: Contribution to journalArticle

154 Citations (Scopus)

Abstract

Background - The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial demonstrated the survival advantage of emergency revascularization versus initial medical stabilization in patients developing cardiogenic shock after acute myocardial infarction. The relative merits of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with shock have not been defined. The objective of this analysis was to compare the effects of PCI and CABG on 30-day and 1-year survival in the SHOCK trial. Methods and Results - Of the 302 trial patients, 128 with predominant left ventricular failure had emergency revascularization. The selection of revascularization procedures was individualized. Eighty-one patients (63.3%) had PCI, and 47 (36.7%) had CABG. The median time from randomization to intervention was 0.9 hours (interquartile range [IQR], 0.3 to 2.2 hours) for PCI and 2.7 hours (IQR, 1.3 to 5.5 hours) for CABG. Baseline demographics and hemodynamics were similar, except that there were more diabetics (48.9% versus 26.9%; P=0.02), 3-vessel disease (80.4% versus 60.3%; P=0.03), and left main coronary disease (41.3% versus 13.0%; P=0.001) in the CABG group. In the PCI group, 12.3% had 2-vessel and 2.5% had 3-vessel interventions. In the CABG group, 84.8% received ≥2 grafts, 52.2% received ≥3 grafts, and 87.2% were deemed completely revascularized. The survival rates were 55.6% in the PCI group compared with 57.4% in the CABG group at 30 days (P=0.86) and 51.9% compared with 46.8%, respectively, at 1 year (P=0.71). Conclusions - Among SHOCK trial patients randomized to emergency revascularization, those treated with CABG had a greater prevalence of diabetes and worse coronary disease than those treated with PCI. However, survival rates were similar. Emergency CABG is an important component of an optimal treatment strategy in patients with cardiogenic shock, and should be considered a complementary treatment option in patients with extensive coronary disease.

LanguageEnglish
Pages1992-2001
Number of pages10
JournalCirculation
Volume112
Issue number13
DOIs
Publication statusPublished - 27 Sep 2005

Keywords

  • Angioplasty
  • Mortality
  • Myocardial infarction
  • Shock
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

White, Harvey D. ; Assmann, Susan F. ; Sanborn, Timothy A. ; Jacobs, Alice K. ; Webb, John G. ; Sleeper, Lynn A. ; Wong, Cheuk Kit ; Stewart, James T. ; Aylward, Philip E G ; Wong, Shing Chiu ; Hochman, Judith S. / Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock : Results from the should we emergently revascularize occluded coronaries for cardiogenic shock (SHOCK) trial. In: Circulation. 2005 ; Vol. 112, No. 13. pp. 1992-2001.
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title = "Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock: Results from the should we emergently revascularize occluded coronaries for cardiogenic shock (SHOCK) trial",
abstract = "Background - The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial demonstrated the survival advantage of emergency revascularization versus initial medical stabilization in patients developing cardiogenic shock after acute myocardial infarction. The relative merits of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with shock have not been defined. The objective of this analysis was to compare the effects of PCI and CABG on 30-day and 1-year survival in the SHOCK trial. Methods and Results - Of the 302 trial patients, 128 with predominant left ventricular failure had emergency revascularization. The selection of revascularization procedures was individualized. Eighty-one patients (63.3{\%}) had PCI, and 47 (36.7{\%}) had CABG. The median time from randomization to intervention was 0.9 hours (interquartile range [IQR], 0.3 to 2.2 hours) for PCI and 2.7 hours (IQR, 1.3 to 5.5 hours) for CABG. Baseline demographics and hemodynamics were similar, except that there were more diabetics (48.9{\%} versus 26.9{\%}; P=0.02), 3-vessel disease (80.4{\%} versus 60.3{\%}; P=0.03), and left main coronary disease (41.3{\%} versus 13.0{\%}; P=0.001) in the CABG group. In the PCI group, 12.3{\%} had 2-vessel and 2.5{\%} had 3-vessel interventions. In the CABG group, 84.8{\%} received ≥2 grafts, 52.2{\%} received ≥3 grafts, and 87.2{\%} were deemed completely revascularized. The survival rates were 55.6{\%} in the PCI group compared with 57.4{\%} in the CABG group at 30 days (P=0.86) and 51.9{\%} compared with 46.8{\%}, respectively, at 1 year (P=0.71). Conclusions - Among SHOCK trial patients randomized to emergency revascularization, those treated with CABG had a greater prevalence of diabetes and worse coronary disease than those treated with PCI. However, survival rates were similar. Emergency CABG is an important component of an optimal treatment strategy in patients with cardiogenic shock, and should be considered a complementary treatment option in patients with extensive coronary disease.",
keywords = "Angioplasty, Mortality, Myocardial infarction, Shock, Surgery",
author = "White, {Harvey D.} and Assmann, {Susan F.} and Sanborn, {Timothy A.} and Jacobs, {Alice K.} and Webb, {John G.} and Sleeper, {Lynn A.} and Wong, {Cheuk Kit} and Stewart, {James T.} and Aylward, {Philip E G} and Wong, {Shing Chiu} and Hochman, {Judith S.}",
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Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock : Results from the should we emergently revascularize occluded coronaries for cardiogenic shock (SHOCK) trial. / White, Harvey D.; Assmann, Susan F.; Sanborn, Timothy A.; Jacobs, Alice K.; Webb, John G.; Sleeper, Lynn A.; Wong, Cheuk Kit; Stewart, James T.; Aylward, Philip E G; Wong, Shing Chiu; Hochman, Judith S.

In: Circulation, Vol. 112, No. 13, 27.09.2005, p. 1992-2001.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock

T2 - Circulation

AU - White, Harvey D.

AU - Assmann, Susan F.

AU - Sanborn, Timothy A.

AU - Jacobs, Alice K.

AU - Webb, John G.

AU - Sleeper, Lynn A.

AU - Wong, Cheuk Kit

AU - Stewart, James T.

AU - Aylward, Philip E G

AU - Wong, Shing Chiu

AU - Hochman, Judith S.

PY - 2005/9/27

Y1 - 2005/9/27

N2 - Background - The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial demonstrated the survival advantage of emergency revascularization versus initial medical stabilization in patients developing cardiogenic shock after acute myocardial infarction. The relative merits of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with shock have not been defined. The objective of this analysis was to compare the effects of PCI and CABG on 30-day and 1-year survival in the SHOCK trial. Methods and Results - Of the 302 trial patients, 128 with predominant left ventricular failure had emergency revascularization. The selection of revascularization procedures was individualized. Eighty-one patients (63.3%) had PCI, and 47 (36.7%) had CABG. The median time from randomization to intervention was 0.9 hours (interquartile range [IQR], 0.3 to 2.2 hours) for PCI and 2.7 hours (IQR, 1.3 to 5.5 hours) for CABG. Baseline demographics and hemodynamics were similar, except that there were more diabetics (48.9% versus 26.9%; P=0.02), 3-vessel disease (80.4% versus 60.3%; P=0.03), and left main coronary disease (41.3% versus 13.0%; P=0.001) in the CABG group. In the PCI group, 12.3% had 2-vessel and 2.5% had 3-vessel interventions. In the CABG group, 84.8% received ≥2 grafts, 52.2% received ≥3 grafts, and 87.2% were deemed completely revascularized. The survival rates were 55.6% in the PCI group compared with 57.4% in the CABG group at 30 days (P=0.86) and 51.9% compared with 46.8%, respectively, at 1 year (P=0.71). Conclusions - Among SHOCK trial patients randomized to emergency revascularization, those treated with CABG had a greater prevalence of diabetes and worse coronary disease than those treated with PCI. However, survival rates were similar. Emergency CABG is an important component of an optimal treatment strategy in patients with cardiogenic shock, and should be considered a complementary treatment option in patients with extensive coronary disease.

AB - Background - The Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial demonstrated the survival advantage of emergency revascularization versus initial medical stabilization in patients developing cardiogenic shock after acute myocardial infarction. The relative merits of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in patients with shock have not been defined. The objective of this analysis was to compare the effects of PCI and CABG on 30-day and 1-year survival in the SHOCK trial. Methods and Results - Of the 302 trial patients, 128 with predominant left ventricular failure had emergency revascularization. The selection of revascularization procedures was individualized. Eighty-one patients (63.3%) had PCI, and 47 (36.7%) had CABG. The median time from randomization to intervention was 0.9 hours (interquartile range [IQR], 0.3 to 2.2 hours) for PCI and 2.7 hours (IQR, 1.3 to 5.5 hours) for CABG. Baseline demographics and hemodynamics were similar, except that there were more diabetics (48.9% versus 26.9%; P=0.02), 3-vessel disease (80.4% versus 60.3%; P=0.03), and left main coronary disease (41.3% versus 13.0%; P=0.001) in the CABG group. In the PCI group, 12.3% had 2-vessel and 2.5% had 3-vessel interventions. In the CABG group, 84.8% received ≥2 grafts, 52.2% received ≥3 grafts, and 87.2% were deemed completely revascularized. The survival rates were 55.6% in the PCI group compared with 57.4% in the CABG group at 30 days (P=0.86) and 51.9% compared with 46.8%, respectively, at 1 year (P=0.71). Conclusions - Among SHOCK trial patients randomized to emergency revascularization, those treated with CABG had a greater prevalence of diabetes and worse coronary disease than those treated with PCI. However, survival rates were similar. Emergency CABG is an important component of an optimal treatment strategy in patients with cardiogenic shock, and should be considered a complementary treatment option in patients with extensive coronary disease.

KW - Angioplasty

KW - Mortality

KW - Myocardial infarction

KW - Shock

KW - Surgery

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U2 - 10.1161/CIRCULATIONAHA.105.540948

DO - 10.1161/CIRCULATIONAHA.105.540948

M3 - Article

VL - 112

SP - 1992

EP - 2001

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 13

ER -