Mortality is substantially lower in patients undergoing coronary bypass grafting vs percutaneous coronary intervention with three-vessel coronary disease and cardiogenic shock in the setting of non-ST-elevation myocardial infarction

The current paradigm emphasizes that early revascularization is crucial for acute myocardial infarction (AMI) with cardiogenic shock, with both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) recognized as life-saving options. However, the choice between multi-vessel PCI and CABG in the specific setting of NSTEMI with cardiogenic shock and multi-vessel disease isn't well-established.

This preprint falls under the classification of Normal Science/Model Drift. It operates within the existing paradigm of early revascularization for AMI with cardiogenic shock. The research seeks to refine the understanding within this paradigm by comparing the outcomes of CABG vs. PCI specifically for NSTEMI patients with three-vessel disease and cardiogenic shock. The study's findings suggest a survival advantage with CABG in this subgroup. While the results don't fundamentally challenge the current paradigm, they contribute to a potential model drift by highlighting a specific clinical scenario where CABG may be superior to PCI. This could influence future treatment algorithms and research directions within the existing paradigm. The limitations acknowledged, such as the retrospective design and potential selection bias, call for prospective studies to solidify the findings and potentially guide a shift in practice toward favoring CABG in this specific patient population. Thus, while operating within the current paradigm, it hints at a potential refinement or drift based on these specific results.