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Is delayed surgical revascularization in acute myocardial infarction useful or dangerous? New insights into an old

Philippe Grieshaber1, Peter Roth1, Lukas Oster1

  • 1Department of Adult and Pediatric Cardiovascular Surgery, Giessen University Hospital, Giessen, Germany.

Interactive Cardiovascular and Thoracic Surgery
|June 23, 2017
PubMed

Insights

Delayed surgery for acute myocardial infarction can lead to dangerous low cardiac output syndrome (LCOS). Immediate surgery or careful patient selection based on risk factors can improve outcomes and survival.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Critical Care Medicine

Background:

  • Delayed coronary artery bypass grafting (CABG) is common for hemodynamically stable patients with acute myocardial infarction (AMI) to mitigate emergency surgery risks.
  • However, delayed surgery may lead to the development of low cardiac output syndrome (LCOS) during the waiting period, a significant complication.
  • This study investigates the risk factors and clinical consequences of preoperative LCOS in AMI patients undergoing delayed CABG.

Purpose of the Study:

  • To identify predictors of preoperative low cardiac output syndrome (LCOS) in patients with acute myocardial infarction (AMI) undergoing delayed coronary artery bypass grafting (CABG).
  • To evaluate the clinical consequences, including mortality and long-term survival, associated with preoperative LCOS.
  • To provide evidence for optimizing surgical timing and patient selection in AMI patients requiring CABG.

Main Methods:

  • A cohort of 530 consecutive patients with AMI undergoing isolated CABG between 2008 and 2013 was analyzed.
  • Outcomes were compared between immediate (<48 hours) and delayed (>48 hours) revascularization strategies.
  • Multivariate regression analysis was employed to identify predictors of preoperative LCOS development.

Main Results:

  • Of 327 patients undergoing delayed therapy, 39 (12%) developed preoperative LCOS, associated with significantly increased mortality (21% vs. 7.6%).
  • Immediate therapy showed similar mortality to delayed therapy (6.4% vs. 7.6%) but superior 7-year survival (70% vs. 55%).
  • Key predictors for LCOS included reduced left ventricular function, renal impairment, acute pulmonary infection, and elevated troponin levels.

Conclusions:

  • Preoperative LCOS is a significant and dangerous complication in AMI patients undergoing delayed CABG.
  • Immediate surgical intervention or careful preoperative risk stratification can help avoid LCOS and improve patient outcomes.
  • Identifying patients at high risk for LCOS allows for personalized treatment strategies, potentially improving survival rates.
Abstract

Keywords:
Acute myocardial infarctionCardiac surgeryCoronary artery bypass grafting

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