Mortality Predictors in ST-Elevated Myocardial Infarction Patients Undergoing Coronary Artery Bypass Grafting

Filizcan, Uğur; Kurç, Erol; Cetemen, Sebnem; Soylu, Özer; Aydogan, Hakki; Bayserke, Olgar; Muruvvet, Yilmaz; Uyarel, Hüseyin; Ergelen, Mehmet; Orhan, Gökçen; Uğurlucan, Murat; Eren, Ergin; Yekeler, İbrahim

doi:10.1177/0003319710369103

Cited by 20 publications

(23 citation statements)

References 17 publications

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“…Dennoch ist ein Zeitraum von mindestens 2-4 Wochen nach einem Myokardinfarkt einzuhalten, da bei Gewebeinstabilität eine zusätzliche Schwächung des Herzmuskels denkbar ist. Die Bypassoperation im akuten Myokardinfarkt ist mit erhöhtem Risiko verbunden [30]. Darüber hinaus ist unklar, ob die akute inflammatorische Reaktion im akuten Myokardinfarkt eine günstigste Plattform für Stammzellen zur vaskulären Differenzierung darstellt, wenn die ablaufende Entzündungskaska-de das zur Verfügung gestellte Zellmaterial in hohem Maß beansprucht [31].…”

Section: Die Intramyokardiale Stammzellinjektionunclassified

Chirurgische intramyokardiale Stammzelltherapie bei chronischer Myokardischämie

Kaminski

Donndorf

Steinhoff

2010

Herz

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Chronic ischemic heart disease patients are already being treated worldwide with bone marrow stem cells both in the context of clinical studies and in therapy trials. By combining this therapy with established revascularization procedures such as bypass surgery, a high level of patient safety can be achieved. To date, no stem cell-related cardiac complications following intramyocardial injection of bone marrow-derived stem cells during CABG (coronary artery bypass graft) surgery have been reported. The functional advantage conferred by surgical bone marrow stem cell therapy is a 7.2% increase in LVEF (left ventricular ejection fraction) compared to controls. Randomized placebo-controlled trials, like the German trial PERFECT, are needed to obtain a more evidence-based assessment of this therapy.

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Section: Die Intramyokardiale Stammzellinjektionunclassified

Chirurgische intramyokardiale Stammzelltherapie bei chronischer Myokardischämie

Kaminski

Donndorf

Steinhoff

2010

Herz

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“…Contemporary non-surgical procedures, fibrinolytic therapy and primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction with ST segment elevation (STEMI), significantly reduce morbidity and mortality. Early surgical revascularization, coronary artery bypass graft (CABG), is reserved for left main and/or 3 vessel coronary disease, ongoing ischemia after successful or not PCI, coronary anatomy not adequate for PCI and mechanical complications of STEMI [1].…”

Section: Introductionmentioning

confidence: 99%

Optimal coronary artery bypass graft timing in high-risk acute myocardial infarction with ST elevation

Jovev¹,

Mitrovska²,

Dameska³

et al. 2017

Russ. Open Med. J.

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Abstract:Background -Despite advances in surgical techniques, still tendency for waiting up to 6 weeks after myocardial infarction with ST segment elevation (STEMI). We aimed to evaluate optimal timing for coronary artery bypass graft (CABG) in stable patients with STEMI. Material and Methods -Prospective, randomised study consisted of 30 patients with STEMI (age 57-78 years, 22 male) underwent onpump CABG. According to the timing of CABG they were stratified as urgent (0-2 day) and late group (3 day and after). Transthoracic echocardiography and selective coronarography were done before surgery. Patients with ejection ftaction (EF) >50%, left main stenosis and/or multivessel coronary disease were included in the study. We excluded patients with mechanical complications, reduced EF, cerebrrovacular insult (CVI), renal failure or respiratory insufficiency. Results -The primary endpoint for 30 days were adverse cardiac events (death, recurrent angina, prolonged mechanical ventilation/IABP insertion CVI, acute kidney injury, major bleeding). Eight (26.6%) patients underwent urgent CABG in first 48 h. due to haemodynamic instability/ongoing ischemia Three (37.5%) of them died and 6 (75%) had prolonged mechanical ventilation support and/or IABP. Twenty two (73.3%) patients in late group were operated after period of stabilization (10-14 day). They were discharged on 6-7 postoperative day. Conclusion -Early surgery may be risky, but its delay also carries the risk of devastating complications. Stable patients operated on 10-14 day had similar outcomes as elective cases.Keywords: acute myocardial infarction with ST elevation, coronary artery bypass graft, intraaortic balloon pump, mechanical ventilation Correspondence to Dr Slavica Mitrovska. Address: Dzole Stojcev br. 1-2/8, 1000 Skopje, Macedonia. E-mail: mitrovska2000@yahoo.com. IntroductionThe myocardial infarction (MI) is the leading cause for death in industrial as well as in the developing countries. Contemporary non-surgical procedures, fibrinolytic therapy and primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction with ST segment elevation (STEMI), significantly reduce morbidity and mortality. Early surgical revascularization, coronary artery bypass graft (CABG), is reserved for left main and/or 3 vessel coronary disease, ongoing ischemia after successful or not PCI, coronary anatomy not adequate for PCI and mechanical complications of STEMI [1].There was a trend in the early 70-ties for an urgent CABG in the patients with acute MI. But, retrospective studies showed an enormous mortality rate in comparison to elective surgery. The end of the 80-ties hypothesized the risk of hemorrhagic transformation from reperfusion and infarct extension, altered recovery and scar formation. Soon after, was introduced the practice to operate patients after 6 weeks of MI with Q wave. But after all these years, the optimal timing of CABG in hemodynamically stable STEMI patients remains controversial.

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“…Diagnosing patients with ACS and determining their treatment alternatives provide valuable information on the prognosis of these patients [9,10]. There are numerous studies which have shown an association between high preoperative and postoperative troponin levels associated with increased morbidity and mortality rates in patients undergoing CABG [11][12][13][14]. This raises the possibility that cardiac troponin levels may be used as a marker for the timing of CABG operations.…”

Section: Introductionmentioning

confidence: 99%

Timing of coronary artery bypass surgery in patients with non-ST-segment elevation myocardial infarction and postoperative outcomes

Özbek¹,

Sever²,

Demirhan³

et al. 2014

aoms

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A b s t r a c t Introduction:The aim of the study was to assess whether a cardiac troponin T (cTnT) level 1 ng/ml or below threshold is safe and to evaluate mid-term follow-up results in stable patients with non-ST-segment elevation after acute myocardial infarction. Material and methods: Among cTnT positive patients who presented to the emergency unit with chest pain and received coronary angiography, 100 patients who underwent isolated coronary artery bypass grafting (CABG) constituted the study group (group 1). The same number of patients (n = 100) who were cTnT negative and underwent an isolated CABG operation under elective conditions were selected as the control group (group 2). Results: Among preoperative criteria, group 1 had significantly higher smoking rates (74% vs. 41%, p = 0.0001), and significantly lower ejection fraction values (47.1 ±8.25, 54.69 ±8.73, p = 0.0001). There were no significant differences between the groups with respect to operative parameters. Postoperative follow-up periods were significantly longer in group 1 (23.25 ±14 vs. 17.55 ±7.95 months, p = 0.001). Average waiting time for cTnT to drop below the 1 ng/ml threshold value was 5.73 ±2.95 (1-12) days. Intra-aortic balloon pump use in Groups 1 and 2 was 3% and 1%, respectively. There were no hospital mortalities in either group. Mortality rates at mid term were 6% in both groups. Conclusions: This study compared two groups positive and negative for preoperative cTnT. The findings show that it is safe to wait until cTnT levels decrease to the 1 ng/ml threshold value in cTnT positive patients having a stable course. This waiting period is not very long, which is significant with respect to potential complications.

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Mortality Predictors in ST-Elevated Myocardial Infarction Patients Undergoing Coronary Artery Bypass Grafting

Cited by 20 publications

References 17 publications

Chirurgische intramyokardiale Stammzelltherapie bei chronischer Myokardischämie

Chirurgische intramyokardiale Stammzelltherapie bei chronischer Myokardischämie

Optimal coronary artery bypass graft timing in high-risk acute myocardial infarction with ST elevation

Timing of coronary artery bypass surgery in patients with non-ST-segment elevation myocardial infarction and postoperative outcomes

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