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Influence of time elapsed between myocardial infarction and coronary artery bypass grafting surgery on operative
Pierre Voisine1, Patrick Mathieu, Daniel Doyle
1Division of Cardiac Surgery, Laval Hospital, 2725 chemin Sainte-Foy, Sainte-Foy, Que., Canada G1V 4G5. pierre.voisine@chg.ulaval.ca
Insights
Timing of coronary artery bypass grafting (CABG) surgery after myocardial infarction (MI) significantly impacts operative mortality. Delaying CABG surgery more than 30 days post-MI is safe, but early surgery within 6 hours to 1 week increases risks, especially for older patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Public Health
Background:
- Optimal timing for Coronary Artery Bypass Grafting (CABG) surgery following a myocardial infarction (MI) is a critical, yet debated, clinical question.
- Patient age and the interval between MI and isolated CABG surgery are key factors influencing perioperative outcomes.
Purpose of the Study:
- To investigate the relationship between the time elapsed since myocardial infarction (MI) and isolated CABG surgery.
- To assess the impact of patient age and the timing of CABG surgery post-MI on operative mortality.
Main Methods:
- A retrospective review of perioperative data for 13,545 patients undergoing isolated CABG surgery between 1991 and 2005.
- Patients with a prior MI (n=7219) were categorized into five groups based on time to surgery: <6h, 6-24h, 1-7 days, 8-30 days, and >30 days.
- Operative mortality rates and odds ratios were calculated, with specific analysis for patients over 65 years.
Main Results:
- Patients undergoing CABG surgery within 6 hours to 1 week after MI exhibited significantly higher operative mortality rates (19.2% and 9.8%, respectively) compared to those operated on >30 days post-MI (2.4%).
- In patients over 65, mortality rates were also elevated in the early post-MI periods (35.7% for <6h, 13.8% for 6-24h, 11.3% for 1-7 days) compared to >30 days (3.9%).
- Odds ratios for operative mortality were highest for surgery between 6 hours and 7 days post-MI, indicating a critical window of increased risk.
Conclusions:
- A history of myocardial infarction (MI) sustained more than 30 days prior to isolated CABG surgery does not adversely affect operative mortality.
- Operative mortality is significantly increased in the period between 6 hours and 1 week following MI, particularly in elderly patients.
- Avoiding isolated CABG surgery during this high-risk window (6 hours to 1 week post-MI) is recommended whenever clinically feasible.
Objective:
Optimal timing for CABG surgery after myocardial infarction (MI) remains controversial. We examined the influence of patient age and time elapsed between MI and isolated CABG surgery on operative mortality.
Methods:
Perioperative data of 13,545 patients who underwent isolated CABG surgery from 1991 to 2005 were reviewed. A previous MI was found in 7219 patients, classified among groups A-E whether they underwent surgery less than 6h (A, n=26), between 6 and 24h (B, n=51), between 1 and 7 days (C, n=313), between 8 and 30 days (D, n=917), or more than 30 days (E, n=5912) after the event. Crude percentages and odds ratio estimates of operative mortality were calculated.
Results:
In patients who had no history of MI, the mortality rate was 1.7%, while it was, respectively, 19.2, 9.8, 8.6, 3.2, and 2.4% in patients from groups A to E. Among 6589 patients over 65 years of age, 3027 had no history of MI. Their mortality was 2.4%, compared to, respectively, 35.7, 13.8, 11.3, 5.1, and 3.9% for those belonging to groups A-E. Overall odds ratio estimates of operative mortality were 3.92 (p=0.19), 5.08 (p=0.002), 4.33 (p=0.0001), 1.50 (p=0.08), and 1.18 (p=0.24) for groups A-E, respectively.
Conclusions:
Operative mortality is not influenced by a history of MI sustained more than 30 days prior to isolated CABG surgery, but is highly and most significantly increased between 6h and 1 week after MI, especially in older patients. That critical period should be avoided whenever possible.
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