[The effect of surgical revascularization on different timing after ST-elevation myocardial infarction on patients
Rong Wang1, Changqing Gao1, Cangsong Xiao1
1Department of Cardiovascular Surgery, Peoples' Liberation Army General Hospital, Institute of Cardiac Surgery of People's Liberation Army, Beijing 100853, China.
Insights
Surgical revascularization after ST-elevation myocardial infarction (STEMI) improves left ventricular function and remodeling. Optimal timing for coronary artery bypass grafting is recommended around three weeks post-STEMI for patients with left ventricular dysfunction.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- ST-elevation myocardial infarction (STEMI) frequently leads to left ventricular dysfunction.
- Coronary artery disease (CAD) with impaired left ventricular function requires effective treatment strategies.
- Surgical revascularization is a key intervention for managing advanced CAD.
Purpose of the Study:
- To analyze the influence of different surgical revascularization timings post-STEMI on patients with CAD and left ventricular dysfunction.
- To evaluate the impact of early, mid-term, and late revascularization on patient outcomes.
- To determine the optimal timing for coronary artery bypass grafting (CABG) after STEMI.
Main Methods:
- Retrospective review of 225 patients with STEMI and ejection fraction <50% who underwent isolated CABG.
- Patients were divided into early (<21 days), mid-term (21-90 days), and late (>90 days) revascularization groups.
- Endpoints included 30-day post-operative mortality and major complications, with assessment of cardiac function and remodeling.
Main Results:
- No significant difference in 30-day mortality across revascularization timing groups.
- Significantly lower mortality from low cardiac output syndrome in mid-term and late revascularization groups compared to early.
- Significant improvement in ejection fraction and reduction in left ventricular end-diastolic dimension observed in mid-term and late groups.
Conclusions:
- Surgical revascularization benefits patients with CAD and left ventricular dysfunction, improving cardiac function and remodeling.
- Short-term outcomes are influenced by patient condition, surgical technique, and perioperative management.
- Revascularization approximately three weeks after STEMI is recommended for this patient cohort.
Objective:
To analysis the influence of surgical revascularization on different timing after ST-elevation myocardial infarction (STEMI) on patients with coronary artery disease and left ventricular dysfunction.
Methods:
Clinical data of 225 patients admitted from January 2003 to July 2012 with history of STEMI and left ventricular dysfunction (ejection faraction<50%) who underwent isolated coronary artery bypass grafting was retrospectively reviewed. There were 186 male and 39 female patients. According to the timing of surgical revascularization after STEMI, the patients were divided into early revascularization group (ER group, <21 days), mid-term revascularization group (MR group, 21 to 90 days) and late revascularization group (LR group, >90 days). There were 20 male and 9 female patients in ER group with mean age of (63 ± 10) years, 48 male and 16 female in MR group with mean age of (63 ± 8) years, 118 male and 14 female in LR group with mean age of (62 ± 10) years, respectively. Thirty-day post-operative mortality and major complications were determined as the endpoints to evaluate the early results of operation.
Results:
The 30-day post-operative mortality were 3.4%,0 and 2.3% among three groups respectively and there was no statistic difference between groups (χ(2) = 2.137, P = 0.330).Low cardiac output syndrome mortality were 13.8%, 3.1% and 2.3% among three groups respectively and there was statistic difference between groups (χ(2) = 8.344, P = 0.015). The ejection fractions was significantly improved in all the three groups from 42% ± 6%, 41% ± 6% and 42% ± 6% preoperatively to 46% ± 7%, 45% ± 10% and 45% ± 9% postoperatively (t = -3.378 to -2.339, all P < 0.05). The left ventricular end diastolic dimension were significantly reduced in MR group and LR group from (54 ± 6) mm and (55 ± 6) mm preoperatively to (47 ± 8) mm and (49 ± 9) mm postoperatively (t = 5.634, 5.885; P = 0.000). There was no significant change in ER group pre- and postoperatively ((51 ± 6) mm vs.(49 ± 7) mm, t = 1.524, P = 0.133).
Conclusions:
The patients with coronary artery disease and left ventricular dysfunction can benefit from surgical revascularization on different timing after STEMI, presenting as the reverse of left ventricle remodeling and the improvement of left ventricle function. The short-term results are mainly determined by the patients' condition, surgical technique and the level of perioperative management.It is recommended for this patient cohort to accept surgical revascularization three weeks after STEMI.
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