Early versus late surgical revascularization after acute myocardial infarction

Ashraf  Elnahas; Mohamed  Saffan; Moataz  Rezk; Mohammed Rostom

Ashraf Elnahas Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mohamed Saffan Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Moataz Rezk Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mohammed Rostom Cardiothoracic Surgery, Luxor International Medical Complex, Egypt Healthcare Authority, Luxor, Egypt

Keywords: Coronary artery bypass grafting, Myocardial infarction, STEMI

Abstract

Background: Optimal timing for coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI) remains contentious. Early surgical intervention may minimize myocardial damage but carries increased risks, while delayed surgery allows myocardial stabilization but may lead to recurrent ischemic events.Our objectives is to compare early (0-3 days post-AMI) versus late (4-30 days post-AMI) surgical revascularization outcomes, focusing on mortality and postoperative complications.

Methods: This prospective cohort comparative study was conducted from June 2023 to May 2024 at three centers in Egypt. Sixty patients (mean age 55.67 ± 9.05 years; 85% male) undergoing CABG within 30 days of AMI were enrolled. Patients were divided into two groups based on timing: Early CABG (0–3 days post-AMI, n=30) and Late CABG (4–30 days post-AMI, n=30). Preoperative, intraoperative, and postoperative data were collected. Outcomes were assessed during hospitalization and at follow-up (mean duration 8.1 ± 1.73 months).

Results: Baseline demographic, angiographic, and echocardiographic characteristics were comparable between groups. The early CABG group showed significantly more akinetic/dyskinetic apical wall motion abnormalities (p = 0.001). In-hospital mortality was higher in the early group though without a significant difference (13.3% vs. 3.3%, p = 0.16). Postoperative complications were significantly more frequent in the early CABG group (33.3% vs. 10%, p = 0.02). The durations of ICU stay (3.83±1.36 vs. 2.37±1.71 days, p = 0.001) and total hospital stay (9.33±3.29 vs. 6.83±3.05 days, p = 0.003) were significantly longer in early CABG. Odds of complications were 4.5 times higher in early CABG while mortality odds showed a non-significant trend toward increase.

Conclusion: Early CABG may be associated with increased postoperative complications, necessitating careful patient selection and perioperative management. Delayed CABG allows for myocardial stabilization, potentially reducing perioperative risks.