Long-term survival and quality of life of patients submitted to emergency coronary artery bypass grafting for post-infarction cardiogenic shock

Background: This study was intended to evaluate the long-term outcome of patients submitted to emergency coronary artery bypass (eCABG) for postinfarction cardiogenic shock (post-AMI CS). Methods: Sixty-seven consecutive patients were submitted to eCABG for post-AMI CS at two European institutions during an 11 year period. Pre-, intra-, postoperative and long-term follow-up data of all patients were prospectively collected. Results: Hospital survival was 86% (58/67) with all deaths due to cardiac causes. At a mean follow-up of 78±48 months (range 1-153) 43 of the 58 patients discharged from the hospital were alive (74%); 9 of the 15 late deaths (60%) were non cardiac. Overall survival rate at the end of follow-up was 64% (43/67). The majority (41/43, 95%) of survivors were in NYHA class I-II, ischemia free, had a Karnofsky performance status > 80 and an excellent quality of life basing on the Seattle Angina Questionnaire. The use of the internal thoracic artery (Figure 1) and of cardiopulmonary bypass (Figure 2) were both associated with significantly better long-term survival (p=.01 for both). Conclusions: The long-term survival and quality of life of patients submitted to eCABG for post-AMI CS are good; eCABG should be considered a valuable therapeutic option in this setting. The use of cardiopulmonary bypass and of the internal thoracic artery at the time of surgery are strongly advocated.