Outcome of Stable Patients With Acute Myocardial Infarction and Coronary Artery Bypass Surgery Within 48 Hours: A Single‐Center, Retrospective Experience

Abstract

BackgroundThe optimal timing of coronary artery bypass grafting (CABG) in clinically stable patients with acute myocardial infarction who are unsuitable for percutaneous coronary intervention is unclear. We report our experience with early CABG in these patients.Methods and ResultsBetween January 2001 and May 2015, 766 patients with ST‐segment–elevation myocardial infarction (STEMI, n=305) or non‐STEMI (NSTEMI, n=461) not including cardiogenic shock underwent CABG within 48 hours at our department. STEMI patients were younger than non‐STEMI patients (age 65 years [range: 58–72] versus 70 years [range: 62–75], P<0.001) with a lower EuroSCORE II (4.12 [range: 2.75–5.81] versus 4.58 [range: 2.80–7.74], P=0.009). STEMI patients had undergone preoperative percutaneous coronary intervention more often (20.3% versus 7.8%, P<0.001). Time to surgery was shorter in STEMI compared with non‐STEMI patients (5.0 hours [range: 3.2–8.8] versus 11.7 hours [range: 6.4–22.0], P<0.001). No significant differences concerning arterial graft use (93.8% versus 94.8%, P=0.540) or complete revascularization (87.5% versus 83.4%, P=0.121) were observed. The rate of strokes did not differ between the groups (2.0% versus 3.9%, P=0.134). Thirty‐day mortality was lower in STEMI patients (2.7% versus 6.6% P=0.018), especially when CABG was performed within 6 hours (1.8% versus 7.1%, P=0.041). Survival of STEMI and non‐STEMI patients was 94% versus 88% after 1 year (P<0.001), 87% versus 73% after 5 years (P<0.001), and 74% versus 57% after 10 years (P<0.001). Independent predictors of 30‐day and long‐term mortality included preoperatively increased lactate values, age, atrial fibrillation, and reduced left ventricular function.ConclusionsStable STEMI patients showed a lower rate of perioperative complications and better survival compared with non‐STEMI patients when CABG was performed within 48 hours.

Outcome of acute myocardial infarction versus stable coronary artery disease patients treated with coronary bypass surgery

“…In agreement with previous studies of ACS and MI patients [ 9 , 15 ], we found in-hospital mortality to be significantly higher when CABG was performed for patients with MI (8.6%) compared to patients with stable CAD (1.6%). This mortality rate is well in line with previous findings of 2.7–21.6% early mortality after CABG in MI patients [ 7 , 15 ]. Increased mortality of MI patients is associated with higher risk of both procedural (e.g.…”

“…Increased mortality of MI patients is associated with higher risk of both procedural (e.g. early bypass dysfunction) and MI related complications [7,15], reflected also to a longer hospitalization period after surgery found in our data. Optimal timing of CABG after MI for maximal benefitrisk gain is unclear [15,16].…”

“…Since we did not study post-CABG parameters (such as pharmacotherapy, laboratory results including markers of myocardial cell destruction such as creatine kinase, or development of left ventricular systolic function after MI), our study is unable to highlight detailed mechanisms of poorer outcome in MI patients. It is plausible that reduced left ventricle ejection fraction contributes for poorer long-term outcome in CABG patient following MI [ 7 ].…”

“…In acute MI and stable CAD, the choice of revascularization by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) is based on clinical presentation, patients age and comorbidities and coronary lesion characteristics [ 2–4 ]. Revascularization by CABG improves outcomes in stable multivessel or left-main CAD [ 5 ] and has good results also in MI patients not suitable to percutaneous treatment [ 6 , 7 ]. Acute coronary syndrome (ACS), including both unstable angina pectoris (UA) and MI, is an independent risk-factor for early mortality after CABG [ 8 , 9 ].…”

Cardiac surgery in acute myocardial infarction: crystalloid versus blood cardioplegia – an experimental study

“…In this setting, the optimal timing of CABG has been a matter of debate for decades. More recent data suggest that immediate surgery is equally safe and possibly associated with improved outcomes compared to delaying surgery for some days after the acute event [2,3]. If immediate CABG is the method chosen for myocardial revascularization, the procedure is usually carried out using a heart-lung machine [4].…”