Timing of Coronary Artery Bypass Grafting Surgery after Acute Myocardial Infarction
Background: Optimal timing for CABG surgery after myocardial infarction remains a matter of debate. The aim of our study was to analyze the effect of timing of CABG after acute myocardial infarction on operative mortality and morbidity.
Methods: This prospective study included 60 patients who underwent isolated CABG within 30 days of acute myocardial infarction over 20 months (from the first of November 2014 till the end of June 2016) in Kasr Al-Ainy University Hospitals. Patients were divided into two groups; the early group (0 – 3 days) included 14 patients (23.3%) and the late group (4 – 30 days) included 46 patients (76.7%). The primary outcome was all-cause hospital mortality.
Results: Our study included 43 males (71.7%) and 17 females (28.3%). The mean age was 58.4 ± 7.3 years. The total mortality rate was 8.3%. Patients undergoing early CABG experienced a higher mortality rate than those undergoing late CABG (21.4% vs 4.3%, P = 0.043). Also, early CABG was associated with more postoperative complications. Cardiogenic shock and early CABG were independent risk factors of mortality.
Conclusion: CABG in the first 3 days after acute myocardial infarction was associated with high mortality and morbidity in comparison with late CABG. This suggests that CABG may best be deferred for more than 3 days after acute MI in non-urgent cases.
2. Caceres M, Weiman DS. Optimal timing of coronary artery bypass grafting in acute myocardial infarction. Ann. Thorac. Surg. 2013; 95 (1): 365-372.
3. Weiss ES, Chang DD, Joyce DL, Nwakanma LU, Yuh DD. Optimal timing of coronary artery bypass after acute myocardial infarction: a review of California discharge data. J. Thorac. Cardiovasc. Surg. 2008; 135 (3): 503-511.
4. Voisine P, Mathieu P, Doyle D, et al. Influence of time elapsed between myocardial infarction and coronary artery bypass grafting surgery on operative mortality. Eur. J. Cardiothorac. Surg. 2006; 29 (3): 319-323.
5. Chen HL, Liu K. Timing of coronary artery bypass graft surgery for acute myocardial infarction patients: a meta-analysis. Int. J. Cardiol. 2014; 177 (1): 53-56.
6. Acharya D, Gulack BC, Loyaga-Rendon RY, et al. Clinical characteristics and outcomes of patients with myocardial infarction and cardiogenic shock undergoing coronary artery bypass surgery: data from the society of thoracic surgeons national database. Ann. Thorac. Surg. 2016; 101 (2): 558-566.
7. Khaladj N, Bobylev D, Peterss S, et al. Immediate surgical coronary revascularisation in patients presenting with acute myocardial infarction. J. Cardiothorac. Surg. 2013; 8: 167.
8. Ladeira RT, Jatene FB, Monteiro R, et al. Coronary artery bypass grafting in acute myocardial infarction: Analysis of preoperative predictors of mortality. Arq. Bras. Cardiol. 2006; 87 (3): 254-259.
9. Assmann A, Boeken U, Akhyari P, Lichtenberg A. Appropriate timing of coronary artery bypass grafting after acute myocardial infarction. Thorac. Cardiovasc. Surg. 2012; 60 (07): 446-451.
10. Chew DP, Mahaffey KW, White HD, et al. Coronary artery bypass surgery in patients with acute coronary syndromes is difficult to predict. Am. Heart. J. 2008; 155 (5): 841-847.
11. Bárta J, Brát R, Gaj J, Kolek M, Novobilský K, Porzer M. Immediate coronary artery bypass graft surgery for acute coronary syndrome–Outcomes and trends over the past eight years. Cor et Vasa. 2015; 57 (2): e63-e69.
12. Nichols EL, McCullough JN, Ross CS, et al. Optimal timing from myocardial infarction to coronary artery bypass grafting on hospital mortality. Ann. Thorac. Surg. 2017; 103 (1): 162-171.
13. Abd-Alaal MM, Alsabban MA, Abbas OA, Alshaer AA, Al-Saddique A, Fouda M. Timing of revascularization after acute myocardial infarction. Asian. Cardiovasc. Thorac. Ann. 2010; 18 (2):118-121.
14. Deeik RK, Schmitt TM, Ihrig TG, Sugimoto JT. Appropriate timing of elective coronary artery bypass graft surgery following acute myocardial infarction. Am. J. Surg. 1998; 176 (6): 581– 585.
15. Lee DC, Oz MC, Weinberg AD, Lin SX, Ting W. Optimal timing of revascularization: transmural versus nontransmural acute myocardial infarction. Ann. Thorac. Surg. 2001; 71 (4): 1197-1202.
16. Bana A, Yadava OP, Ghadiok R, Selot N. Myocardial revascularisation after acute myocardial infarction. Int. J. Cardiol. 1999; 69 (2): 209-216.
17. Thielmann M, Neuhäuser M, Marr A, et al. Predictors and outcomes of coronary artery bypass grafting in ST elevation myocardial infarction. Ann. Thorac. Surg. 2007; 84 (1): 17-24.
18. Creswell LL, Moulton MJ, Cox JL, Rosenbloom M. Revascularization after acute myocardial infarction. Ann. Thorac. Surg. 1995; 60 (1): 19-26.
19. Nishi H, Sakaguchi T, Miyagawa S, et al. Optimal coronary artery bypass grafting strategy for acute coronary syndrome. Gen. Thorac. Cardiovasc. Surg. 2014; 62 (6): 357-363.