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

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 on-pump 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