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[Myocardial revascularization after reperfusion in the acute phase of myocardial infarction]
F B Jatene1, M B Jatene, A C Monteiro
1Instituto do Coração do Hospital das Clínicas, FMUSP.
Insights
Performing coronary artery bypass grafting (CABG) later after acute myocardial infarction (AMI) reperfusion significantly reduces mortality. Delayed CABG, averaging seven days post-reperfusion, showed better outcomes than immediate surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Context:
- Acute myocardial infarction (AMI) management involves reperfusion strategies.
- Coronary artery bypass grafting (CABG) is a critical intervention for complex cases.
- Timing of CABG after reperfusion requires careful consideration.
Purpose:
- To evaluate the outcomes of coronary artery bypass grafting (CABG) following successful reperfusion therapy in acute myocardial infarction (AMI).
- To compare the mortality rates associated with early versus delayed CABG after reperfusion.
Summary:
- A study of 245 patients with AMI who underwent reperfusion therapy found that 47 patients (19.2%) required CABG.
- Patients were divided into two groups: early CABG (average 47 hours post-reperfusion) and delayed CABG (average 7 days post-reperfusion).
- The delayed CABG group exhibited significantly lower mortality (8%) compared to the early CABG group (21%).
Impact:
- Delayed CABG (mean 7 days) after reperfusion for AMI is associated with improved patient outcomes and reduced mortality.
- These findings suggest an optimal timing strategy for CABG in the context of acute myocardial infarction management.
- The study highlights the importance of a multifactorial analysis in determining the best surgical approach post-reperfusion.
Purpose:
To evaluate the coronary artery bypass grafting (CABG) after successful coronary reperfusion (CR) by streptokinase and/or percutaneous transluminal coronary angioplasty in acute myocardial infarction (AMI).
Patients And Methods:
During 65-months period, 245 patients underwent CR during AMI. In 47 (19.2%) CABG were performed in the acute period due to multi-vessel disease (31%), residual lesion (20%) and post-reperfusion angina (17%). There were two distinct periods: in the first, between Jun/81 and Jun/83, 34 patients underwent CABG, 47 hours average after reperfusion; in the second, between Jul/83 and Nov/86, 13 patients underwent CABG, 7 days average after reperfusion.
Results:
There were 7 deaths (21%) in the first period and 1 (8%) in the second one.
Conclusion:
After a multifactorial analysis the authors concluded that better results with inferior mortality (p less than 0.05) were obtained when CABG was performed later (mean 7 days) than in the immediate post-reperfusion period (mean 47 hours).