Coronary Bypass Surgery Is Associated with Lower Mortality Compared to Percutaneous Coronary Intervention in Patients Presenting with Left Main ST-elevation myocardial infarction (STEMI) Associated with Cardiogenic Shock

Background: ST-elevation myocardial infarction (STEMI) involving the left main coronary artery is frequently complicated by cardiogenic shock. We sought to compare in-hospital outcomes of coronary bypass grafting (CABG) vs. percutaneous coronary intervention (PCI) in left main STEMI complicated with cardiogenic shock using a large national inpatient database. Method: We identified patients aged >18 years with STEMI involving the left main coronary artery complicated by cardiogenic shock, who underwent revascularization with either PCI or CABG, from 2016 to 2020 using the Nationwide Inpatient Sample (NIS) database. Results: A total of 1,050 weighted patients with left main STEMI and cardiogenic shock underwent revascularization (about 68% with PCI and 32% with CABG). Some comorbidities, such as diabetes, smoking, chronic kidney disease, COPD, and hyperlipidemia, were more prominent in the PCI cohort, including higher use of mechanical support except for intra-aortic balloon pump use. In-hospital mortality was markedly higher in the PCI group (55.0% vs. 15.7%; p< 0.001). To adjust for confounding factors, we included numerous high-risk characteristics, including the use of mechanical support, in the multivariate analysis. Despite adjustment for high-risk characteristics, the utilization of PCI remained significantly associated with a more than 5-fold mortality (OR: 5.47, CI 1.67-17.95, p=0.005). Patients undergoing CABG had longer hospitalizations (median length of stay, 10.5 days vs. 4 days for PCI; p < 0.001) and higher median total hospital charges. Conclusion: In this national analysis of the left main STEMI with cardiogenic shock, CABG was associated with dramatically lower in-hospital mortality despite multivariate adjustment than PCI.