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Coronary bypass for relief of persistent pain following acute myocardial infarction
Insights
Urgent coronary bypass grafting after myocardial infarction (MI) shows good long-term survival. Operating within one week of MI increases perioperative complications, but outcomes are similar to elective surgery after seven days.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Acute myocardial infarction (MI) can necessitate urgent revascularization.
- Clinical instability following MI presents a challenge for surgical timing.
Purpose of the Study:
- To evaluate the outcomes of urgent coronary bypass grafting (CABG) performed within 30 days of acute MI.
- To determine the optimal timing for CABG to minimize perioperative complications.
Main Methods:
- Retrospective analysis of 116 patients undergoing urgent CABG within 30 days of acute MI.
- Patients were grouped based on the timing of surgery: within 24 hours, 2-7 days, and 8-30 days post-MI.
- Outcomes including mortality, perioperative complications, and long-term survival were assessed.
Main Results:
- No hospital deaths occurred in the entire cohort.
- Patients operated on within 7 days of MI had higher rates of inotropic support, intraaortic balloon pumping, ventricular arrhythmias, and perioperative infarction.
- Late mortality was low (5 deaths), with 18-month actuarial survival at 97%.
- 71% of patients remained pain-free, and graft patency was 84%.
Conclusions:
- Urgent coronary bypass grafting can be performed safely within 30 days of acute myocardial infarction.
- Operating within the first week post-MI is associated with increased perioperative morbidity.
- Coronary bypass grafting after one week offers similar morbidity to elective procedures, with excellent long-term outcomes.
Abstract:
Between January, 1976, and April, 1980, 116 patients had urgent myocardial revascularization for clinical instability within 30 days of acute myocardial infarction (MI). Group 1 (8 patients) had coronary bypass grafting within 24 hours of acute MI; Group 2 (20 patients) had coronary bypass grafting 2 to 7 days after acute MI; and Group 3 (88 patients) had coronary bypass grafting 8 to 30 days after infarction. Indications for operation were persistent or recurrent pain (81%), pain plus ventricular arrhythmias (12%), and pain plus compelling anatomy. The incidence of single-vessel, triple-vessel, and left main coronary artery disease was 28%, 31%, and 12%, respectively. There were no hospital deaths in the series. The incidence of inotropic requirements, postoperative intraaortic balloon pumping, ventricular arrhythmias, and perioperative infarction was higher in patients operated on within 7 days of acute MI than for patients having coronary bypass grafting after this time. There have been 5 late deaths during a mean follow-up of 14 months. Actuarial survival was 97% at 18 months. Seventy-one percent of patients are presently pain free. Graft patency was 84% in 17 patients recatheterized after coronary bypass grafting and in 14 patients, grafts placed into the area of infarction were patent. This study suggests that the frequency of perioperative complications will be increased in patients operated on within one week of MI, but after this period, coronary bypass grafting can be accomplished with the same morbidity as the of elective operation.