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Author Spotlight: Enhancing Coronary Artery Revascularization
Published on: September 15, 2023
[Coronary artery bypass grafting in non-ST-segment elevation acute myocardial infarction]
A A Fokin1, K A Kireev1, S V Netisanov2
1Railway Clinical Hospital at the Chelyabinsk Station of the Open Joint-Stock Company 'Russian Railways', Chelyabinsk, Russia; South Ural State Medical University of the RF Ministry of Public Health, Chelyabinsk, Russia.
Insights
Coronary artery bypass grafting without artificial circulation showed comparable immediate results for acute myocardial infarction and chronic ischemic heart disease. Lethality and complication rates were similar, irrespective of surgery timing for acute myocardial infarction patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery
Background:
- Non-ST-segment elevation acute myocardial infarction (NSTEMI) patients often require urgent intervention.
- Coronary artery bypass grafting (CABG) without artificial circulation is a viable option for selected patients.
- Comparing outcomes in NSTEMI versus chronic ischemic heart disease (CIHD) undergoing off-pump CABG is crucial.
Purpose of the Study:
- To compare the immediate surgical outcomes of off-pump CABG in patients with NSTEMI versus CIHD.
- To evaluate the impact of surgical timing on outcomes in NSTEMI patients undergoing off-pump CABG.
Main Methods:
- A comparative study involving 101 NSTEMI patients and 108 CIHD patients undergoing off-pump CABG.
- Patients with NSTEMI had more complex coronary artery disease (higher SYNTAX score) and poorer ventricular function.
- Data on lethality, complication rates, and timing of surgery were collected and analyzed.
Main Results:
- Lethality rates were 3.0% in the NSTEMI group and 0.9% in the CIHD group (p<0.05).
- Overall complication rates were 17.8% for NSTEMI and 9.3% for CIHD (p>0.05).
- No significant difference in lethality or complications was observed between NSTEMI and CIHD groups when adjusted for other factors, and NSTEMI lethality was independent of surgical delay.
Conclusions:
- Immediate results of off-pump CABG for NSTEMI are comparable to those for CIHD.
- Delayed surgery in NSTEMI patients did not significantly increase lethality or complication rates.
- Off-pump CABG is a safe and effective revascularization strategy for both NSTEMI and CIHD.
Aim:
The study was aimed at comparatively assessing the immediate results of coronary artery bypass grafting operations without artificial circulation performed in non-ST-segment elevation acute myocardial infarction and chronic ischaemic heart disease.
Patients And Methods:
The main group with non-ST-segment elevation acute myocardial infarction enrolled a total of 101 patients undergoing coronary artery bypass grafting without artificial circulation. The patients' age varied from 47 to 87 years, median 66.0 years (60.0; 71.0). The indication for the operation was persistent myocardial ischaemia on the background of carried out therapy with impossibility of performing percutaneous coronary intervention due to anatomy of coronary arteries and peculiarities of their pathology. The comparison group of chronic ischaemic heart disease was composed of 108 patients undergoing elective coronary artery bypass grafting without artificial circulation. The patients' age varied from 40 to 92 years, median - 60.0 years (58.0; 68.0). The patients with acute myocardial infarction had a significantly greater (p<0.05) number of coronary arteries measuring in diameter 2.5 mm and more, with significant occlusive and stenotic lesions, as well as a higher total SYNTAX score. The patients undergoing elective surgery were found to have an initially higher (p<0.05) left ventricular ejection fraction.
Results:
In the group of acute myocardial infarction the waiting times for coronary artery bypass grafting varied from 2 to 8 days, median of waiting - 4.0 days (4.0; 5.0). The lethality rate (p<0.05) in the group of acute myocardial infarction amounted to 3.0% (3 cases) and in the group of chronic ischaemic heart disease to 0.9% (1 case). Twenty-one (20.8%) operations were carried out within the first 72 hours, with eighty surgical interventions (79.2%) performed after 72 hours from the onset of the disease. All 3 (3.8%) lethal outcomes were observed after coronary artery bypass grafting procedures performed later than 72 hours from the onset of acute myocardial infarction (p>0.05). The total number of complications (p>0.05) amounted to 18 (17.8%) and 10 (9.3%) in the group of acute myocardial infarction and in the group of chronic ischaemic heart disease, respectively.
Conclusion:
The immediate results of delayed coronary artery bypass grafting procedures without artificial circulation for acute myocardial infarction and chronic ischaemic heart disease were statistically comparable (p>0.05) by the lethality and complication rates. Lethality in the group of non-ST-segment elevation acute myocardial infarction din not depend on the time of operation after the onset of the disease.
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