Outcomes of Percutaneous Coronary Intervention for Cardiogenic Shock After Coronary Artery Bypass Graft

We conducted a retrospective cohort study of adults with myocardial infarction (MI) and cardiogenic shock during the index hospitalization after coronary artery bypass graft (CABG) surgery using the United States TriNetX (2006 to 2025) database, comparing those who underwent percutaneous coronary intervention (PCI: ≤24 h) to those who did not. Outcomes were reported as unadjusted and adjusted hazard ratios (HRs) or subdistribution HRs (sHRs) using propensity score matching and Fine–Gray models. The primary endpoint was 30-day all-cause mortality. Secondary endpoints included 30-day hospitalizations for MI, stroke, heart failure (HF), and all-cause hospitalization. Sensitivity analyses included a falsification endpoint (bone fracture) and landmark analyses by PCI timing (≤12 h vs 12 to 24 h). Among 218,827 patients, 22,762 underwent PCI. Compared with those who did not undergo PCI, PCI was associated with lower rates of all-cause mortality (4.5% vs 5.7%), MI (5.0% vs 7.0%), stroke (2.5% vs 5.0%), HF (15.0% vs 28.0%), and all-cause hospitalization (20.0% vs 28.0%). These estimates remained consistent after adjustment for all-cause mortality (HR, 0.88 [95% CI, 0.80 to 0.96]), MI (sHR 0.86 [0.79 to 0.94]), stroke (sHR 0.41 [0.37 to 0.46]), HF (sHR 0.52, 0.50 to 0.55), and all-cause hospitalization (sHR 0.70 [0.67 to 0.73]). PCI showed no association with hospitalization for bone fracture (HR, 0.82 [0.62 to 1.10). Landmark analyses revealed similar trends for mortality at both ≤12 h and 12 to 24 h intervals. In conclusion, PCI was associated with lower 30-day mortality and cardiovascular outcomes after CABG-related cardiogenic shock. These findings are hypothesis-generating and warrant confirmation in prospective studies.