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Evaluation of coronary artery bypass grafting in acute myocardial infarction
Hideyuki Fumoto1, Ryuzo Sakata, Yoshihiro Nakayama
1Department of Cardiovascular Surgery, Kumamoto Central Hospital, Kumamoto, Japan.
Insights
Coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) shows low risk. Key factors for survival include managing hemodynamics and revascularizing main coronary arteries, especially avoiding cardiogenic shock.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) poses significant risks.
- Coronary artery bypass grafting (CABG) is a potential treatment option for AMI.
Purpose of the Study:
- To evaluate the operative risk factors and outcomes of CABG in patients with AMI.
- To identify independent risk factors for hospital mortality in this patient group.
Main Methods:
- Retrospective analysis of 1,450 patients undergoing isolated CABG over 12 years.
- Focus on 66 patients who underwent CABG during the AMI phase, divided into deceased and survivor groups.
- Univariate and multivariate analyses of preoperative and intra-operative parameters.
Main Results:
- Total operative mortality was 12.1%.
- Independent risk factors for mortality included diabetes mellitus, cardiogenic shock, and left main trunk AMI.
- Zero mortality was observed in patients without cardiogenic shock.
Conclusions:
- Maintaining hemodynamic stability in the early phase of AMI is crucial for successful CABG.
- Revascularization of main coronary artery branches is a critical element of surgical intervention.
- CABG for AMI can be performed with relatively low risk when key factors are managed.
Objectives:
We evaluated coronary artery bypass grafting (CABG) in acute myocardial infarction (AMI) within 14 days of onset.
Methods:
Of 1,450 patients undergoing isolated CABG in the last 12 years we retrospectively analyzed operative risk factors and studied the use of CABG in treating AMI in 66 undergoing surgery during the AMI phase. We divided them into 2 groups: Group D (deceased: n = 8) and Group S (survivors: n = 58).
Results:
Total operative mortality was 12.1% (8/66). Univariate analysis showed the following preoperative parameters to be significant in Group D: diabetes mellitus, cardiogenic shock, shortness of the interval between AMI onset and surgery, mean peak creatine phosphokinase-MB, AMI of the left main trunk, and failed recanalization of the infarcted artery. Multivariate analysis showed diabetes mellitus, cardiogenic shock, and AMI of the left main trunk as independent risk factors for hospital mortality. Intra-operative parameters between groups showed no statistical difference. Mortality in patients who did not suffer cardiogenic shock was zero.
Conclusion:
Maintenance of hemodynamics in the early phase is vital in treating AMI. The most important element in surgical intervention is revascularization of main branches. We concluded that CABG in AMI involves relatively low risk.
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