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Myocardial revascularisation after acute myocardial infarction
A Bana1, O P Yadava, R Ghadiok
1Department of Cardiac Surgery, Sir Ganga Ram Hospital Marg, Rajinder Nagar, New Delhi, India. gangaram@giasdl01.vsnl.net.in
International Journal of Cardiology
|November 5, 1999
Summary
Coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI) is safe for stable patients with post-infarct angina. Urgent surgery, cardiogenic shock, and poor left ventricular function increase risks.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Coronary artery bypass grafting (CABG) is a critical intervention for patients experiencing acute myocardial infarction (AMI).
- Persistent or recurrent angina post-MI often necessitates surgical consideration.
- Timing and patient selection are crucial for optimizing outcomes after CABG in the context of AMI.
Purpose of the Study:
- To evaluate the safety and outcomes of CABG performed within 30 days of AMI.
- To identify predictors of morbidity, complications, and mortality in patients undergoing early CABG post-MI.
- To assess the long-term efficacy of CABG for managing post-infarct angina.
Main Methods:
- Retrospective analysis of 123 patients who underwent CABG within 30 days of AMI (May 1992 - November 1997).
- Data collection included infarct characteristics, surgical indications, pre-operative support (inotropes, IABP), and procedural details (complete revascularization).
- Multivariate analysis was used to identify independent predictors of post-operative morbidity, complications, and 30-day mortality.
Main Results:
- The most common infarct was anterior transmural (61.8%), and the primary indication for surgery was post-infarct angina (69.1%).
- Thirty-day mortality was 3.3%. Independent predictors of mortality included LVEF <30%, Q-wave MI, surgery <48 hours post-AMI, pre-operative cardiogenic shock, and age >60 years.
- Post-operative morbidity and complications were associated with factors such as prolonged ventilation, ICU stay, re-exploration, arrhythmias, pulmonary complications, CVA, and wound infection.
Conclusions:
- CABG can be performed with low risk in stable patients following AMI for post-infarct angina.
- Urgent/emergent surgery, pre-operative cardiogenic shock, IABP use, poor left ventricular function, advanced age, and Q-wave MI are associated with increased risk.
- Careful patient selection and risk stratification are essential for successful early CABG after AMI.