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Surgical revascularization after acute myocardial infarction in patients with end-stage renal disease

Gregory D Trachiotis1, Devika Hanumara, Leanne McKenna

  • 1Division of Cardiothoracic Surgery, The George Washington University, Veterans Affairs Medical Center, 50 Irving Street, NW Sec 112, Washington, DC 20422, USA. gtrachiotis@mfa.gwu.edu

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|September 29, 2004
PubMed

Insights

Coronary artery bypass grafting (CABG) is a viable option for patients with end-stage renal disease (ESRD) experiencing acute myocardial infarction (AMI). Outcomes were similar to those with remote myocardial infarction, suggesting early CABG is a safe treatment strategy.

Area of Science:

  • Cardiology
  • Nephrology
  • Cardiovascular Surgery

Background:

  • Cardiovascular disease is the leading cause of death in end-stage renal disease (ESRD) patients.
  • Acute myocardial infarction (AMI) in ESRD patients carries a high mortality rate and poor long-term survival.
  • The efficacy of coronary artery bypass grafting (CABG) during AMI in ESRD patients is not well-defined.

Purpose of the Study:

  • To evaluate the perioperative outcomes of CABG in ESRD patients who underwent the procedure during an AMI.
  • To compare these outcomes with ESRD patients who had a remote myocardial infarction (RMI) at the time of CABG.

Main Methods:

  • A retrospective study of 342 ESRD patients (serum creatinine >2.0mg/dl or dialysis dependence) who underwent CABG between 1995 and 2000.
  • Patients were divided into two groups: those with AMI (<7 days prior to CABG) and those with RMI (>7 days prior to CABG).
  • Demographic, clinical, and perioperative data were compared between the AMI and RMI groups.

Main Results:

  • Patient characteristics, including age, sex, creatinine levels, and dialysis dependence, were similar between the AMI and RMI groups.
  • Surgical approaches, such as multivessel CABG, off-pump CABG (OPCAB), and arterial conduit use, were comparable in both groups.
  • Postoperative pulmonary complications and atrial fibrillation were more frequent in the AMI group, but hospital mortality was similar (10% vs. 8.5%, P=0.88).

Conclusions:

  • ESRD patients undergoing CABG, whether for AMI or RMI, represent a high-risk population.
  • Selecting patients for early CABG during AMI in the setting of ESRD appears to be a safe and viable therapeutic strategy.
  • The study supports considering CABG as an early treatment option for ESRD patients experiencing AMI.
Abstract

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