Timing of coronary artery bypass grafting after acute myocardial infarction: does it influence outcomes?

Abstract

Introduction: The optimal timing of coronary artery bypass grafting (CABG) operations in patients with recent acute myocardial infarction (AMI) remains unclear. Aim: To assess the influence of timing on post-operative outcomes in patients undergoing CABG following AMI. Material and methods: In this retrospective analysis 12,224 consecutive patients undergoing CABG were included. 2477 (20.5%) patients had a history of AMI. Based on timing, patients were divided into 3 groups: those operated within 7 days of AMI; those operated after 7 days but within 1 month; and a third group operated after 1 month but within 3 months. The 3 groups were compared in terms of baseline, intra-operative, and post-operative morbidity and mortality. Multivariate analysis was carried out to assess the independent influence of timing of CABG on outcomes. Results: There was no difference in terms of previous neurological events (p = 0.554), presence of carotid artery disease (p = 0.555), prevalence of hypertension (p = 0.119), diabetes (p = 0.144), hypothyroidism (p = 0.53), chronic obstructive pulmonary disease (p = 0.079), peripheral vascular disease (p = 0.771), and impaired left ventricular function (p = 0.072). On univariate analysis, mortality risk was highest between 1 week and 1 month (p = 0.003). Multivariate analysis showed that the closer the MI and CABG duration, the higher the mortality (co-efficient -0.517; p = 0.019; odds ratio = 0.596; 95% CI: 0.388-0.917). Conclusions: The duration between MI and CABG has a direct influence on outcomes after CABG. While it is clear that the longer the duration between MI and CABG, the lower the mortality risk, it is however difficult to decide on an exact cut-off time frame.

Cardiac magnetic resonance imaging for myocardial viability assessment: Optimizing surgical revascularization in ischemic heart disease

“…The technique of OPCAB was standard using stabilization devices and intra-coronary shunts in all cases as described previously. 7 In all cases, complete revascularization was performed, irrespective of the viability status. The selection of conduits utilized during the procedure depended on the surgeon's preference and the decision to use arterial conduits was based on the degree of stenosis observed in the target vessel.…”

The role of cardiac surgery in the treatment of acute coronary syndrome with stelevation

“…Всички те действат в синергия и експоненциално усилват ефектите на мултисистемното инфламаторно състояние, предизвикано от миокардната исхемия, причинявайки тежки патофизиологични феномени с огромна смъртност: рефрактерна левокамерна дисфункция, увеличаване зоната на инфаркта, глобално зашеметяване на миокарда, синдром на "каменното" сърце, остра бъбречна недостатъчност, остър респираторен дистрес синдром и др. [9,10]. Този негативен опит ограничава ролята на АКБ при STЕМI, но в няколко изключително тежки клинични сценария хирургията е единствена терапевтична възможност.…”

“…All these, exponentially increase the eff ect of subacute hyperinfl ammatory state induced by myocardial ischemia and cause severe pathophysiological phenomena with very high mortality rate, refractory LV dysfunction, enlargement of infarcted size, global myocardial stunning, stone heart syndrome, acute renal failure, respiratory distress syndrome, etc. [9,10]. The role of CABG for STEMI treatment continues to be a subject of discussion, despite its negative experience and serves as the only therapeutic option for several extremely severe clinical scenarios.…”

“…Въпреки тези данни поведението при пациенти със STЕМI, както вече беше споменато няколко пъти, се подчинява на напълно различен алгоритъм, целящ ранна таргетна реперфузия. Независимо от наличието на МКБ, диабет или други фактори, фаворитизиращи оперативното лечение, основното терапевтично поведение при STЕМI е ППКИ на "виновния" съд [9].…”

“…Management of STEMI patients, as already mentioned several times, should submit to completely diff erent algorithm, aiming early target vessel reperfusion. Regardless presence of MVD, diabetes, or any other diagnostic issues favoring surgery, the main therapeutic option should be PCI of the culprit vessel [9].…”