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Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
Total arterial revascularization in patients with acute myocardial infarction - feasibility and outcomes
Philippe Grieshaber1, Lukas Oster2, Tobias Schneider3
1Department of Adult and Pediatric Cardiovascular Surgery, University Hospital Giessen, Rudolf-Buchheim-Str. 7, DE-35392, Giessen, Germany. Philippe.grieshaber@chiru.med.uni-giessen.de.
Insights
Total arterial revascularization (TAR) is safe and effective for patients with acute myocardial infarction (AMI) undergoing coronary artery bypass grafting (CABG). TAR does not increase procedural time and may improve long-term survival compared to saphenous vein grafting.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery
- Vascular Surgery
Background:
- Total arterial revascularization (TAR) is often avoided in acute myocardial infarction (AMI) with coronary artery bypass grafting (CABG) due to perceived technical challenges.
- Saphenous vein (SV) grafting is typically preferred for faster harvesting and simpler anastomosis.
- This study investigates the current feasibility and outcomes of TAR versus SV grafting in emergency AMI patients.
Purpose of the Study:
- To evaluate the technical feasibility and safety of TAR compared to SV grafting in AMI patients undergoing CABG.
- To assess short-term and mid-term clinical outcomes, including procedural time, bleeding complications, and mortality.
- To determine if TAR offers superior long-term survival benefits in this patient population.
Main Methods:
- Retrospective analysis of 434 consecutive patients undergoing CABG for AMI between 2008 and 2014.
- Comparison of procedural data and outcomes between patients receiving TAR and those receiving a combination of internal mammary artery and SV grafts.
- Propensity score matching was employed to create comparable groups for analysis.
Main Results:
- After matching, 250 patients (98 TAR, 152 SV) were analyzed. Procedural times were similar (211 min for TAR vs. 200 min for SV, p=0.46).
- Erythrocyte transfusion rates were significantly higher in the SV group (76% vs. 57%, p<0.001).
- Thirty-day mortality rates were comparable (3.4% TAR vs. 4.5% SV, p=0.68), with a trend towards improved 7-year survival after TAR (75% vs. 62%, p=0.12).
Conclusions:
- Total arterial revascularization (TAR) is technically feasible and safe for patients with acute myocardial infarction (AMI) undergoing coronary artery bypass grafting (CABG).
- TAR does not prolong revascularization time and is associated with reduced need for blood transfusions.
- TAR demonstrates a trend towards improved long-term survival and should be considered the preferred strategy in the clinical setting of AMI.
Background:
In acute situations such as acute myocardial infarction (AMI) with indication for coronary artery bypass grafting (CABG), total arterial revascularization (TAR) is often rejected in favour of saphenous vein (SV) grafting, which is assumed to allow for quicker vessel harvesting, a simpler anastomosis technique, and thus quicker revascularization and fewer bleeding complications. The aim of this study was to evaluate whether reluctance to apply TAR in AMI is still justified from a technical point of view in the current era and whether superiority of TAR results is also evident in emergency patients with AMI undergoing CABG.
Methods:
In this retrospective analysis of 434 consecutive patients undergoing CABG for AMI with either TAR or with a combination of one internal mammary artery and SV grafts between 2008 and 2014, procedural data, short-term and mid-term outcome were compared. Propensity score matching of the groups was performed.
Results:
After propensity score matching, 250 patients were included in the analysis (TAR group: n = 98; SV group n = 152). The procedural time (TAR group: 211 min vs. SV group: 200 min, p = 0.46) did not differ between the groups. Erythrocyte transfusion rates were higher in the SV group (76% vs. 57%; p < 0.001). Rates of re-exploration for bleeding did not differ. Thirty-day mortality rates were comparable (TAR group: 3.4% vs. SV group: 4.5%, p = 0.68). Kaplan-Meier analysis until 7 years postoperatively revealed a tendency for improved survival after TAR (75% vs. 62%; log-rank p = 0.12).
Conclusion:
TAR neither impairs rapid revascularization nor reduces its safety in patients with AMI. It may result in improved long-term outcome and should be preferred in the clinical setting of AMI.
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