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Published on: March 27, 2018
Coronary artery bypass surgery within 48 hours after cardiac arrest due to acute myocardial infarction
Christina Grothusen1, Christine Friedrich1, Tim Attmann1
1Department of Cardiovascular Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Insights
Early coronary artery bypass grafting (CABG) after cardiac arrest (CA) in acute myocardial infarction patients, while controversial, shows promising outcomes. This study found that CABG is a viable strategy with acceptable in-hospital and long-term mortality rates.
Area of Science:
- Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Cardiac arrest (CA) in acute myocardial infarction (AMI) patients typically carries a poor prognosis.
- Coronary artery bypass grafting (CABG) is a controversial revascularization strategy for AMI patients with CA due to risks like stroke and trauma, especially when percutaneous intervention is not feasible.
Purpose of the Study:
- To investigate the outcomes of patients with AMI who underwent CABG following CA.
- To identify predictors of in-hospital and long-term mortality in this patient cohort.
- To assess the neurological outcomes using the cerebral performance category scale.
Main Methods:
- A retrospective analysis of 129 patients who underwent CABG within 48 hours of CA due to AMI between January 2001 and January 2015.
- Analysis of in-hospital and long-term mortality predictors.
- Evaluation of neurological outcomes based on the cerebral performance category scale.
Main Results:
- The majority of CA events (47%) occurred out-of-hospital, with ventricular fibrillation being the primary arrhythmia (71%).
- Patients often had ST-elevation myocardial infarction (65%) and 3-vessel coronary artery disease (84%).
- The stroke rate was 9%, hypoxic brain damage occurred in 12%, and 30-day mortality was 23%, with a 30% long-term mortality. Notably, 79% of survivors had good neurological outcomes.
Conclusions:
- Despite initial reluctance, early CABG in AMI patients with CA appears to be a potentially favorable strategy.
- The study suggests that the risks associated with this procedure may be less severe than previously suspected.
Objectives:
Cardiac arrest (CA) in patients with acute myocardial infarction is associated with a poor prognosis. Due to the additional trauma, risk of stroke and lack of data, coronary artery bypass grafting (CABG) is a controversial revascularization strategy for patients who cannot be treated percutaneously. Against this background, we investigated the outcome of patients from our department with acute myocardial infarction undergoing CABG after CA.
Methods:
Between January 2001 and January 2015, 129 patients with preoperative CA due to acute myocardial infarction underwent CABG at our institution within 48 h after the CA had occurred. Predictors of in-hospital and long-term mortality were analysed. Neurological outcome according to cerebral performance category scale was investigated.
Results:
Sixty CA (47%) events occurred out-of-hospital. Ventricular fibrillation was the major underlying arrhythmia ( n = 92, 71%). The mean age was 65 ± 10 years. Eighty-four patients (65%) were diagnosed with ST-elevation myocardial infarction and 108 patients (84%) had 3-vessel coronary artery disease. Forty-three cases (33%) underwent percutaneous transluminal angioplasty. The median time to CABG was 4 (range 0.2-4) h. Complete revascularization was achieved in 106 patients (83%). The stroke rate was 9% ( n = 11) and hypoxic brain damage occurred in 16 patients (12%). Nine subjects (7%) needed extracorporeal life support. Four intraoperative deaths (3%) occurred; the 30-day mortality rate was 23% ( n = 30); the mortality rate during follow-up was 30% ( n = 27). A total of 79% ( n = 70) of patients discharged alive showed good neurological outcome according to the cerebral performance category scale.
Conclusions:
Despite the reluctance to expose patients with CA to early CABG, our data indicate that the operative strategy may not be as unfavourable as suspected.
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