Coronary bypass operation following acute complicated myocardial infarction

Nunley, David L.; Grunkemeier, Gary L.; Teply, Joseph F.; Abbruzzese, Pietro A.; Davis, John Staige; Khonsari, Siavosh; Starr, Albert

doi:10.1016/s0022-5223(19)37530-0

Cited by 48 publications

(6 citation statements)

References 29 publications

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“…Studies in patients with recent MI confirmed the superiority of OPCAB over conventional CABG in this group. 4,15,17 Evaluating early and late mortality in our patients who had MI <24h before surgery, we noticed that the majority underwent conventional CABG. This emphasizes the importance of using OPCAB in patients with early acute MI.…”

Section: Discussionmentioning

confidence: 93%

Off-Pump Coronary Artery Bypass for Emergency Myocardial Revascularization

Darwazah¹,

Sham'a²,

Isleem³

et al. 2009

Asian Cardiovasc Thorac Ann

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Emergency coronary artery bypass is associated with increased operative mortality. The objective of this study was to evaluate the efficiency and safety of off-pump emergency coronary artery bypass, and to compare the outcome with that of the conventional on-pump procedure. Data of 79 patients who underwent emergency isolated coronary artery bypass were reviewed retrospectively; 45 had off-pump coronary bypass and 34 had conventional surgery. In the off-pump group, mean ejection fraction was significantly lower (28% +/- 9% vs. 39% +/- 10%), and there were fewer grafts per patient (1.8 +/- 0.7 vs. 3.2 +/- 0.8). Early mortality was higher in the conventional surgery group (14.7% vs. 8.9%), but late mortality was similar in both groups. Patients who had on-pump surgery had lower rates of recurrent angina (16% vs. 34%) and symptoms of heart failure (20% vs. 51%). Re-hospitalization was more common in off-pump patients, but cardiac re-interventions were similar. There was no significant difference in 5-year survival rates. The results of off-pump coronary bypass were better than the preoperative predicted EuroSCORE, thus it was concluded that patients treated on an emergency basis should have an off-pump revascularization procedure.

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Section: Discussionmentioning

confidence: 93%

Off-Pump Coronary Artery Bypass for Emergency Myocardial Revascularization

Darwazah¹,

Sham'a²,

Isleem³

et al. 2009

Asian Cardiovasc Thorac Ann

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“…We operated 72.2% of patients within first 6 hours after onset of chest pain. A previously published article by Nunley has reported the mortality rate of AMI patients who underwent on-pump surgery within the first 48 hours of AMI was 7.7%, compared with 0% after 48 hours [ 19 ]. Lee et al have reported similar mortality rates [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Off-pump versus on-pump coronary artery bypass grafting in acute coronary syndrome: a clinical analysis

Kaya

Cavolli

Telli

et al. 2010

J Cardiothorac Surg

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BackgroundAlthough off-pump coronary artery bypass (OPCAB) surgery has many beneficial effects compared with on-pump surgery, switch to on-pump surgery has significantly higher risks of operative mortality. Benefits of OPCAB over on-pump surgery strategies concerning myocardial revascularization are still debatable. We have aimed to develop an "algorithm of off-pump surgical strategy" on preventing conversion to on-pump. This clinical study reports our clinical outcome of OPCAB in patients with acute coronary syndrome.MethodsBetween January 2006 and December 2008, 198 patients with acute coronary syndrome were enrolled in the study. Decision of OPCAB (142 patients) or on-pump surgery (56 patients) was made according to patients' present clinical status and our surgical background. Cardiac enzymes, duration of the surgery, graft numbers, stay in intensive care unit were recorded.ResultsOPCAP group has shorter operation time (82.78 min versus 164.22 min, p < 0.001), lesser necessity for intra-aortic balloon pumping (3.5% versus 12.5%, p = 0.053), shorter duration of intensive care unit stay (p < 0.05) and hospital stay (p < 0.001) compared to on-pump patients. EuroSCORE level was lower in OPCAP group (p < 0.001). None of the patients of OPCAB group required conversion to on-pump technique.ConclusionsThe patients who admitted to the hospital with acute coronary syndrome within "golden hours" (within 6 hours after onset) had a greater chance for OPCAB surgery. This study proves that EuroSCORE is likely to be an important factor in deciding which surgical technique to use, but a further investigation is needed to verify. According to our findings, a careful evaluation of coronary angiography, hemodynamic status, quality of target coronary vessel and timing of surgery are important for OPCAB surgery to avoid conversion to on-pump. By a careful systematic evaluation of the patients as explained with this article, it can be prevent or reduce conversion to on-pump surgery during OPCAB surgery.

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“…Surgical series of patients with postinfarction angina report triple-vessel disease in 3 1-94% and left main disease in 7-20 % . [13][14][15][16][17][18] The selection bias in these series is obvious. Nevertheless, when we looked at our patients who were revascularized, the incidence of triple-vessel and left main disease combined increased to only 30%.…”

Section: Discussionmentioning

confidence: 99%

Cardiac catheterization for patients with postinfarction angina

Tomlinson

Kern

Lancaster

et al. 1987

Clinical Cardiology

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Summary: A retrospective review was conducted to determine the incidence of cardiac catheterization for postinfarction angina, the associated coronary anatomy, and the subsequent clinical course. Over one year, 30 of 178 myocardial infarctions were complicated by postinfarction angina resulting in cardiac catheterization. This was 18% of cardiac catheterizations for evaluation of coronary artery disease. Among the 30 patients, 3 had left main disease, 3 had triple-vessel disease, 1 1 had double-vessel disease, 11 had single-vessel disease, and 2 had no significant disease. Nine patients had proximal left anterior descending disease without left main disease. In contrast to previous autopsy or surgical series, the extent of coronary artery involvement was less severe and followed a distribution similar to that found in uncomplicated myocardial infarctions. Nevertheless, 17 of the 30 patients underwent revascularization with angioplasty or bypass surgery compared with 41 of 137 without postinfarction angina @=0.01). Clinical characteristics of the patients with postinfarction angina did not predict who would ultimately require revascularization. Cardiac catheterization is necessary for management of patients with postinfarction angina, because a majority of them will require revascularization.Key words: angina pectoris, angioplasty, aortocoronary bypass, myocardial infarction, myocardial revascularizationThe views expressed herein are those of the authors and not necessarily those of the United States Air Force.

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Coronary bypass operation following acute complicated myocardial infarction

Cited by 48 publications

References 29 publications

Off-Pump Coronary Artery Bypass for Emergency Myocardial Revascularization

Off-Pump Coronary Artery Bypass for Emergency Myocardial Revascularization

Off-pump versus on-pump coronary artery bypass grafting in acute coronary syndrome: a clinical analysis

Cardiac catheterization for patients with postinfarction angina

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