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Published on: March 27, 2018
Predictors and outcomes of coronary artery bypass grafting in ST elevation myocardial infarction
Matthias Thielmann1, Markus Neuhäuser, Anja Marr
1Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, Essen, Germany. matthias.thielmann@uni-due.de
Insights
Coronary artery bypass grafting (CABG) for ST-elevation myocardial infarction (STEMI) shows acceptable risk with proper management. Key predictors of mortality include female sex, elevated cardiac troponin I, cardiogenic shock, and time to operation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- ST-elevation myocardial infarction (STEMI) treatment has evolved significantly with percutaneous coronary intervention (PCI).
- Surgical revascularization via coronary artery bypass grafting (CABG) remains an option for STEMI patients.
- Assessing CABG outcomes in STEMI is crucial for treatment strategy refinement.
Purpose of the Study:
- To evaluate the outcomes of patients with ST-elevation myocardial infarction (STEMI) who underwent coronary artery bypass grafting (CABG).
- To identify predictors of in-hospital mortality and major adverse cardiac events (MACE) following CABG in STEMI patients.
Main Methods:
- Retrospective analysis of prospectively recorded data from 138 consecutive STEMI patients undergoing CABG (2000-2007).
- Data screened included preoperative, intraoperative, and postoperative variables.
- Outcomes assessed were in-hospital mortality and major adverse cardiac events (MACE).
Main Results:
- Overall in-hospital mortality was 8.7%, with significant variation based on time from symptom onset to CABG.
- Mortality was higher with delays in surgery (e.g., 23.8% at 7-24 hours vs. 2.4% at 8-14 days).
- Independent predictors of mortality and MACE included age, female sex, elevated preoperative cardiac troponin I, and cardiogenic shock.
Conclusions:
- Coronary artery bypass grafting (CABG) for ST-elevation myocardial infarction (STEMI) can be performed with acceptable risk.
- Adequate management strategies are essential for improving outcomes.
- Female sex, preoperative cardiac troponin I levels, cardiogenic shock, and time to operation are critical factors influencing mortality and morbidity.
Background:
Treatment of ST-elevation myocardial infarction has undergone great evolution since introduction of percutaneous coronary intervention (PCI). The purpose was therefore to assess the outcome of patients with ST-elevation myocardial infarction undergoing surgical revascularization with coronary artery bypass grafting (CABG).
Methods:
A total of 138 consecutive patients with ST-elevation myocardial infarction underwent CABG therapy between January 2000 and January 2007 at our institution. Prospectively recorded preoperative, intraoperative, and postoperative data were retrospectively screened for in-hospital mortality and major adverse cardiac events (MACE).
Results:
The delay between the onset of ST-elevation myocardial infarction symptoms and CABG procedures was within 6 hours in 37 patients, 7 to 24 hours in 21, 1 to 3 days in 15, 4 to 7 days in 24, and 8 to 14 days in 41 patients. Cardiogenic shock (Killip class > or = III) was present in 38 patients (28%), and 37 patients (27%) were referred for CABG after failed PCI. Overall in-hospital mortality was 8.7%, but mortality varied between 10.8% (< or = 6 hours), 23.8% (7 to 24 hours), 6.7% (1 to 3 days), 4.2% (4 to 7 days), and 2.4% (8 to 14 days), depending on time interval from symptom onset to operation. Overall, more nonsurvivors were women (58% versus 23%; p < 0.01), had higher preoperative cardiac troponin I levels (13.2 +/- 9.8 versus 4.5 +/- 4.2 ng/ml; p < 0.0001), and were more frequently in cardiogenic shock (83% versus 22%; p < 0.0001). Unadjusted univariable and risk-adjusted multivariable logistic regression analysis revealed age, female sex, preoperative cardiac troponin I levels, and cardiogenic shock to be the most potent predictors of in-hospital death and MACE.
Conclusions:
CABG in ST-elevation myocardial infarction can be performed with acceptable risk by incorporating adequate management strategies. However, female sex, preoperative cardiac troponin I level, preoperative cardiogenic shock, and time to operation are major variables of mortality and morbidity results.
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