B. A. Adesibikan1, J. Hwabejire2, T. Oyetunji3, M. Williams1, S. Siram1, E. Cornwell1, W. Greene4 1Howard University College Of Medicine,Washington, DC, USA 2Massachusetts General Hospital,Boston, MA, USA 3Children’s Mercy Hospital- University Of Missouri Kansas City,Kansas City, MO, USA 4Emory University School Of Medicine,Atlanta, GA, USA
Introduction: The ability of patients who had prior coronary intervention for coronary arterial disease to withstand major traumatic hemorrhagic shock is unknown. In this study, we examined clinical outcomes in blunt trauma patients with a history of prior coronary intervention (coronary artery bypass graft, CABG, or percutaneous coronary intervention with stenting) who developed hemorrhagic shock
Methods: This is an analysis of the Inflammation and the Host Response to Injury Database. All patients who had a history of pre-injury coronary intervention were selected for analysis.
Results: There were 67 patients who met criteria for inclusion in the study. Their mean age was 67 years (σ=13). The majority (93%) were Whites. The mortality in this cohort was 19.4%, compared to 15.9 % in those with no prior history of coronary intervention (p=0.438). In the coronary intervention group, patients who died following shock were older (78 ±9 vs. 66 ±13 years, p=0.002), hypotensive on presentation (ER systolic BP 91±22 mmHg vs. 110 ±31 p=0.039), had higher ER lactate (5.6 ±3.2 vs. 3.6 ±2.3 mg/dL, p=0.016), had higher APACHE II score (33.5 ±5.2 vs. 28.2 ±8.7 p=0.038), and received more blood products (2839±1883 vs. 1793±1270 mL, p=0.019). There was no difference in Injury Severity Score (ISS), incidence of abdominal compartment syndrome, rate of acute respiratory distress syndrome (ARDS), or rate of post-injury myocardial infarction between survivors and non-survivors. Survivors were more likely to have a pre-injury history of myocardial infarction (33.3% vs. 0, p=0.014) while non-survivors were more likely to have a pre-injury history of congestive heart failure (38.4% vs. 13.0%, p=0.046). Age was the only independent predictor of mortality in the multivariable analysis mortality (OR: 1.14, CI 1.03-1.26, p=0.014).
Conclusion: In patients with prior coronary intervention who suffered blunt traumatic hemorrhagic shock, age is an independent predictor of mortality. The role of pre-injury congestive heart failure as a potential risk factor for mortality in this cohort deserves further study.