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Optimal Timing of Surgical Revascularization for Myocardial Infarction and Left Ventricular Dysfunction
Rong Wang1, Nan Cheng1, Cang-Song Xiao1
1Department of Cardiovascular Surgery, People's Liberation Army General Hospital, Beijing 100853, China.
Insights
Timing of coronary artery bypass grafting (CABG) after ST-segment elevation myocardial infarction (STEMI) with left ventricular dysfunction (LVD) does not impact survival. Early revascularization (<3 weeks) increases risk of low cardiac output syndrome.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Optimal timing for surgical revascularization in ST-segment elevation myocardial infarction (STEMI) patients with left ventricular dysfunction (LVD) remains unclear.
- This study investigated the impact of revascularization timing on outcomes in patients with ischemic heart disease and LVD post-STEMI.
Purpose of the Study:
- To compare early, mid-term, and late surgical revascularization outcomes after STEMI in patients with LVD.
- To identify risk factors for long-term survival following revascularization in this patient cohort.
Main Methods:
- Retrospective analysis of 264 patients with STEMI and LVD undergoing isolated coronary artery bypass grafting (CABG) between 2003-2013.
- Patients were categorized into early (<3 weeks), mid-term (3 weeks-3 months), and late (>3 months) revascularization groups.
- Mortality, complication rates, and long-term survival were compared using Fisher's exact test and Cox regression analysis.
Main Results:
- No significant differences in 30-day mortality, long-term survival, or heart failure rehospitalization were observed among the revascularization timing groups.
- Early revascularization (<3 weeks) was associated with a significantly higher incidence of low cardiac output syndrome (12.90%) compared to mid-term (2.89%) and late (3.05%) groups.
- Severe preoperative condition, not the timing of CABG, was identified as a significant risk factor for long-term survival.
Conclusions:
- Surgical revascularization for STEMI patients with LVD can be performed at various intervals post-STEMI with similar long-term survival and operative mortality.
- Early revascularization (<3 weeks) is linked to an increased risk of postoperative low cardiac output syndrome.
- Preoperative patient condition is a more critical determinant of long-term survival than the timing of CABG after STEMI.
Background:
The optimal timing of surgical revascularization for patients presenting with ST-segment elevation myocardial infarction (STEMI) and impaired left ventricular function is not well established. This study aimed to examine the timing of surgical revascularization after STEMI in patients with ischemic heart disease and left ventricular dysfunction (LVD) by comparing early and late results.
Methods:
From January 2003 to December 2013, there were 2276 patients undergoing isolated coronary artery bypass grafting (CABG) in our institution. Two hundred and sixty-four (223 male, 41 females) patients with a history of STEMI and LVD were divided into early revascularization (ER, <3 weeks), mid-term revascularization (MR, 3 weeks to 3 months), and late revascularization (LR, >3 months) groups according to the time interval from STEMI to CABG. Mortality and complication rates were compared among the groups by Fisher's exact test. Cox regression analyses were performed to examine the effect of the time interval of surgery on long-term survival.
Results:
No significant differences in 30-day mortality, long-term survival, freedom from all-cause death, and rehospitalization for heart failure existed among the groups (P > 0.05). More patients in the ER group (12.90%) had low cardiac output syndrome than those in the MR (2.89%) and LR (3.05%) groups (P = 0.035). The mean follow-up times were 46.72 ± 30.65, 48.70 ± 32.74, and 43.75 ± 32.43 months, respectively (P = 0.716). Cox regression analyses showed a severe preoperative condition (odds ratio = 7.13, 95% confidence interval 2.05-24.74, P = 0.002) rather than the time interval of CABG (P > 0.05) after myocardial infarction was a risk factor of long-term survival.
Conclusions:
Surgical revascularization for patients with STEMI and LVD can be performed at different times after STEMI with comparable operative mortality and long-term survival. However, ER (<3 weeks) has a higher incidence of postoperative low cardiac output syndrome. A severe preoperative condition rather than the time interval of CABG after STEMI is a risk factor of long-term survival.
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