D-96 | CABG is Associated with Better Outcomes in Patients with SCAD and Cardiogenic Shock When Compared with Conservative Management: A Nationwide Study

Background: There is limited data comparing the safety and efficacy of coronary artery bypass graft (CABG) with conservative management in patients with spontaneous coronary artery dissection (SCAD) and cardiogenic shock.We examined and compared the outcomes and complications of CABG and conservative treatment in SCAD patients with cardiogenic shock.Methods: Patients with SCAD and cardiogenic shock, 18 years old between 2018 and 2021 were identified from the National Inpatient Sample Database.Those who underwent CABG were compared to those who did not using multivariate logistic regression analyses.Results: Of the 1674 patients with SCAD and cardiogenic shock, 573 underwent CABG.The median age was 71 (21-90), 1126 (73%) were white, 559 (33%) were female, 1307 (78%) had HTN, 1160 (69%) had CHF, and 806 (48%) had DM.Those who underwent CABG were found to have a decreased risk of mortality, adjusted odds ratio (aOR) 0.23 (95% confidence interval [CI] 0.20-0.26);p-value <0.0001, heart failure aOR 0.53 (0.48-0.58); <0.0001, myocardial infarction aOR 0.47 (0.43-0.52); <0.0001, AKI aOR 0.70 (0.64-0.76); <0.0001, mechanical ventilation aOR 0.58 (0.52-0.65); <0.0001, in-hospital cardiac arrest aOR 0.26 (0.22-0.32); <0.0001, and heart block aOR 0.65 (0.57-0.73); <0.0001.However, those who underwent CABG were found to have an increased risk of bleeding aOR 7.03 (6.36-7.78);<0.0001, vasopressor use aOR 1.14 (1.02-1.26);0.016, and ECMO use aOR 2.31 (1.72-3.09);<0.0001.Conclusions: Patients with SCAD and cardiogenic shock who underwent CABG had a lower risk of mortality and better in-hospital outcomes when compared to those who did not undergo CABG.Further research is needed to identify modifiable risk factors for better outcomes in this patient population.