Cox ML, et al. - Researchers here sought to assess the outcomes after coronary artery bypass grafting in patients with myocardial infarction, cardiogenic shock and unresponsive neurological state. Despite considerable neurological disability and mortality observed in association with cardiac surgery in unresponsive patients in the setting of acute myocardial infarction complicated by cardiogenic shock, the majority of the patients survived to discharge. The findings could help guiding patient and family discussions regarding goals of care.

Methods

• Researchers identified patients undergoing urgent or emergent CABG within 7 days of an acute myocardial infarction complicated by cardiogenic shock using the Society of Thoracic Surgeons Adult Cardiac Surgery Database from July 2011 to December 2013.
• The patients were stratified on the basis of whether they had a non-medically induced unresponsive state within 24 h of surgery.

Results

• During the study period, 5,259 patients with acute myocardial infarction complicated by cardiogenic shock underwent CABG.
• Of these, 243 (4.62%) patients had an unresponsive preoperative neurological state.
• The unresponsive cohort, compared to the responsive cohort, showed a higher 30-day operative mortality (33.74% vs 16.91%, P < 0.001).
• In this study, unresponsive neurological state was observed to be associated with increased odds for mortality (adjusted odds ratio 1.81, 95% confidence interval 1.37–2.4; P < 0.001), postoperative stroke (adjusted odds ratio 2.17, 95% confidence interval 1.27–3.73; P=0.0048) and encephalopathy (adjusted odds ratio 2.08, 95% confidence interval 1.44–3.01; P < 0.001).
• Seventy-eight (46.15%) were discharged home and 62 (36.69%) were discharged to extended care facilities among survivors in the unresponsive cohort.