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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
On-Pump Beating Heart Versus Conventional Coronary Artery Bypass Grafting Early After Myocardial Infarction: A
Michael Z L Zhu1, Molla M Huq1, Baki M Billah1
1School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.
Insights
On-pump beating heart coronary artery bypass grafting (ONBEAT) is a safe option for high-risk patients needing urgent surgery after acute myocardial infarction (AMI). Outcomes are similar to conventional on-pump stopped-heart CABG.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Acute Myocardial Infarction Management
Background:
- Coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI) carries high mortality risks.
- On-pump beating heart CABG (ONBEAT) avoids cardioplegic arrest and aortic cross-clamping, potentially benefiting high-risk AMI patients.
- This study compares early and long-term outcomes of ONBEAT versus conventional on-pump stopped-heart CABG (ONSTOP).
Purpose of the Study:
- To evaluate the safety and efficacy of ONBEAT compared to ONSTOP in patients undergoing urgent CABG post-AMI.
- To assess both short-term (30-day) and long-term (12-year) survival rates.
- To identify factors associated with the choice of ONBEAT surgery.
Main Methods:
- Utilized the Australia and New Zealand Society of Cardiovascular and Thoracic Surgeons (ANZSCTS) National Cardiac Surgery Database (2001-2015).
- Included 5,851 patients undergoing non-elective on-pump CABG within 7 days of AMI; 77 had ONBEAT, 5774 had ONSTOP.
- Propensity-score matching (1:2 ratio) was used for risk adjustment, with survival data from the National Death Index.
Main Results:
- Unadjusted 30-day mortality was higher for ONBEAT (11.7%) vs. ONSTOP (4.4%).
- After propensity-score matching, 30-day mortality (11.7% vs. 10.4%) and major adverse cardiac and cerebrovascular events (22.1% vs. 24.7%) were similar between ONBEAT and ONSTOP.
- ONBEAT was associated with fewer anastomoses and higher rates of incomplete revascularization, yet 12-year survival was comparable (64.8% vs. 63.6%).
Conclusions:
- On-pump beating heart CABG (ONBEAT) is a safe surgical option for high-risk patients requiring urgent revascularization after acute myocardial infarction (AMI).
- Short-term and long-term survival outcomes for ONBEAT are comparable to conventional on-pump stopped-heart CABG (ONSTOP) in this patient cohort.
- Despite potential for incomplete revascularization, ONBEAT offers similar long-term survival benefits.
Background:
Coronary artery bypass grafting (CABG) performed early after acute myocardial infarction (AMI) carries a high risk of mortality. By avoiding cardioplegic arrest and aortic cross-clamping, on-pump beating heart CABG (ONBEAT) may benefit patients requiring urgent or emergency revascularisation in the setting of AMI. We evaluated the early and long-term outcomes of ONBEAT versus conventional CABG (ONSTOP) utilising the ANZSCTS National Cardiac Surgery Database.
Methods:
Between 2001 and 2015, 5,851 patients underwent non-elective on-pump CABG within 7 days of AMI. Of these, 77 patients (1.3%) underwent ONBEAT and 5774 (98.7%) underwent ONSTOP surgery. Propensity-score matching (with a 1:2 matching ratio) was performed for risk adjustment. Survival data were obtained from the National Death Index.
Results:
Before matching, the unadjusted 30-day mortality was ONBEAT: 9/77 (11.7%) vs. ONSTOP: 256/5,774 (4.4%), p<0.001. Preoperative factors independently associated with the ONBEAT were: septuagenarian age, peripheral vascular disease, redo surgery, cardiogenic shock, emergency surgery and single-vessel disease. After propensity-score matching, 30-day mortality was similar (ONBEAT: 9/77 (11.7%) vs. ONSTOP: 16/154 (10.4%), p=0.85), as was the rate of major adverse cardiac and cerebrovascular events (ONBEAT: 17/77 (22.1%) vs. ONSTOP: 38/154 (24.7%), p=0.84). ONBEAT patients received fewer distal anastomoses and were more likely to have incomplete revascularisation (ONBEAT: 15/77 (19.5%) vs. ONSTOP: 15/154, (9.7%), p=0.03). Despite this, 12-year survival was comparable (ONBEAT: 64.8% (95% CI 39.4-82.4%) vs. ONSTOP: 63.6% (95% CI 50.5, 74.3%), p=0.89).
Conclusions:
ONBEAT can be performed safely in high-risk patients requiring CABG early after AMI with similar short and long-term survival compared to ONSTOP.
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