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Objective: The objective of this study was to find the best treatment strategy in patients who had acute coronary
syndrome and ST-segment elevation myocardial infarction sustaining cardiogenic shock.
Methods: Patients having cardiogenic shock owing to acute coronary syndrome and ST-segment elevation
myocardial infarction who required hemodynamic support with intra-aortic balloon counterpulsation were retrospectively
retrieved from the clinical information system in a tertiary medical center in Taiwan. A propensity
score–based matching process was applied to find equalized groups with documented involvement of more
than 2 coronary vessels who received percutaneous coronary intervention only (PCI only group) and who underwent
subsequent coronary artery bypass graft surgery after percutaneous coronary intervention (PCI юCABG
group). A logistic regression model was used to find the factors associated with 30-day mortality.
Results: The propensity analysis identified 44 patients in the PCI only group (35 men, 652 years, and 9 women,
75 4 years) and the other 44 patients in the PCIюCABG group (31 men, 67 2 years, and 13 women, 71 2
years) who had comparable baseline characteristics. The 30-day mortality, 40.9 % in the PCI only group and
20.5 % in the PCIюCABG group, was positively associated with percutaneous coronary intervention only
(odds ratio, 3.33; 95 % confidence intervals, 1.14–10.0; P ј .03), increased age (odds ratio, 1.06 for each
year; 95 % confidence intervals, 1.01–1.12; P ј .01) and a need to use extracorporeal membrane oxygenation
(odds ratio, 9.64; 95 % confidence intervals, 2.19–42.4; P<.001).
Conclusions: This study has shown the survival benefit of surgical intervention in high-risk patients with acute
coronary syndrome or ST-segment elevation myocardial infarction who had cardiogenic shock after percutaneous
coronary intervention.
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