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Is It Safe to Use Arterial Grafts in Patients with Acute Myocardial Infarction? Short-Mid-Term Propensity Analysis
Leonardo Lacava1, Gabrielle Barbosa Borgomoni2,3, Leticia de Mendonça Lopes1
1Department of Cardiovascular Surgery, Hospital Regional São Paulo (HRSP), Xanxerê, Santa Catarina, Brazil.
Introduction:
The use of multiple arterial grafts (MAGs) has an impact on patient survival; however, preference for its use in the acute phase of myocardial infarction (AMI) has not yet been established. This study aimed to compare the short-mid-term clinical results of AMI patients undergoing coronary artery bypass grafting (CABG) with a single arterial graft (SAG) vs. MAGs.
Methods:
This is a cross-sectional cohort study of 4,053 patients from the Registro Paulista de Cirurgia Cardiovascular II (REPLICCAR II). CABG in the AMI was considered when performed between one and seven days after diagnosis (n=238). Thirty-five patients underwent surgery with ≥ 2 arterial grafts (MAG group), population adjustment in SAG group was performed using the propensity score matching (PSM). Clinical follow-up was performed by telephone to assess need for readmission, new AMI, reoperation, and death.
Results:
After PSM, 70 patients were evaluated. During hospitalization, a significant statistical difference was observed in the surgery duration: the MAG group had a median of 4.78 hours while the SAG group had 4.11 hours (P=0.040). Within the MAG group, there was a predominance use of bilateral internal thoracic artery (62.86%), followed by radial graft associated with the use of left internal thoracic artery (28.57%) and the combination of the three grafts (8.57%). There were no significant differences between the groups in terms of outcomes up to 30 days after CABG or up to five years after CABG.
Conclusion:
In REPLICCAR II, usage of MAGs in the AMI was not associated with clinical worsening of patients until the mid-term follow-up.
Insights
Using multiple arterial grafts (MAGs) for coronary artery bypass grafting (CABG) in acute myocardial infarction (AMI) shows no mid-term clinical disadvantage compared to single arterial grafts (SAGs). This finding supports the use of MAGs in AMI patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Myocardial Infarction Treatment
Background:
- The optimal arterial graft strategy for acute myocardial infarction (AMI) patients undergoing coronary artery bypass grafting (CABG) remains debated.
- Multiple arterial grafts (MAGs) may offer survival benefits, but their use in the acute phase of AMI requires further investigation.
Purpose of the Study:
- To compare the short- to mid-term clinical outcomes of AMI patients treated with CABG using single arterial grafts (SAGs) versus MAGs.
- To evaluate the safety and efficacy of MAGs in the acute setting of myocardial infarction.
Main Methods:
- A cross-sectional cohort study of 4,053 patients from the REPLICCAR II registry.
- Propensity score matching (PSM) was used to compare 35 patients receiving MAGs with a matched cohort receiving SAGs for AMI (n=238), with 70 patients evaluated post-PSM.
- Clinical follow-up assessed readmission, new AMI, reoperation, and mortality.
Main Results:
- Surgery duration was longer in the MAG group (median 4.78 hours) compared to the SAG group (median 4.11 hours) (P=0.040).
- Bilateral internal thoracic artery was the most common MAG configuration (62.86%).
- No significant differences in clinical outcomes were observed between MAG and SAG groups up to five years post-CABG.
Conclusions:
- The use of MAGs in patients with AMI undergoing CABG was not associated with adverse clinical outcomes in the mid-term follow-up.
- These findings suggest that MAGs are a safe and viable option for revascularization in AMI patients.
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