Timing and Outcome of Coronary Artery Bypass Grafting in STEMI: On-Pump and off-Pump Dilemma

Abstract

Background: Our objective in this multicenter retrospective study is to discuss the optimum timing for CABG after STEMI. The second question is whether the Off-Pump technique differs regarding the timing or affects the outcome compared to the On-Pump technique. 36-63years. 195 males in the off-pump patients (97.5%) and 175 males (97.76%) in the on-pump patients. we arranged them into 2main groups; group A as off-Pump and group B as on-pump. Both groups were further subdivided into groups A1 (off-pump early surgery; 100 patients), group A2 (off-pump late surgery; 100 patients) group B1 (on-pump early surgery; 88 patients) and group B2 (late surgery; 91 patients). We excluded patients with Complicated PCI, Mechanical complications, Cardiogenic shock, Life threatening arrhythmias and Late presentation of ischemia or infarction after PCI. MethodsResults: 25 mortalities occurred in early operated cases. There were no intraoperative mortality in the groups operated late after the infarction, and only one late postoperative mortality in group B2. 9 mortalities in group A1 (4.5% of the off-pump CABG-9% of group A1) and 16 mortalities of group B (8.9% of group B, 15 cases in group B1; 17% and 1 case in group B2; 1.09%). There was significant statistical difference between group A and group B, A1 and A2, B1 and B2; regarding the intra-and postoperative mortality with p-value of 0.004, 0.0022, 0.001 intraoperatively and 0.0047, 0.001, 0.003 postoperatively. The postoperative duration for mechanical ventilation was longer in group B than in group A, and longer in group A1 compared to group A2. The use of intra-aortic balloon pump was more in group B than A and more in A1 compared to A2 also more in cases of group B1 than B2. The use of inotropic support was more in group B than A while it was less in A2 than A1 and more in B1 than B2. The total ICU and hospital stay were longer in cases of B than A and more in A1 than A2, also longer in B1 than B2. The intra and post operative arrhythmias and complications were more in A1 than A2 and in B1 than B2. Conclusion:The more we wait after STEMI for surgical intervention for cases not candidate or failed for primary PCI, the better the outcome of surgery With no sharp time limit for postponing the surgery.