Related Experiment Videos
Surgical revascularization after acute myocardial infarction. Does timing make a difference?
C F Sintek1, T A Pfeffer, S Khonsari
1Department of Cardiac Surgery, Southern California Regional Center, Kaiser Permanente Medical Center, Los Angeles 90027.
Insights
Surgical revascularization after acute myocardial infarction (AMI) can be safely performed at any time interval, including after 72 hours. This study found no increased operative mortality for non-emergency procedures, regardless of timing post-AMI.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Research
Background:
- The optimal timing for surgical revascularization following acute myocardial infarction (AMI) remains debated.
- Early cardiac catheterization was performed for patients with postinfarction ischemia or positive stress tests.
Purpose of the Study:
- To evaluate the safety and outcomes of surgical revascularization at various time intervals after acute myocardial infarction.
- To determine if the timing of coronary artery bypass graft (CABG) surgery impacts operative mortality and morbidity.
Main Methods:
- Retrospective analysis of 2175 isolated CABG procedures performed between January 1990 and April 1993.
- Patients were categorized by the time interval between AMI and surgery (within 24 hours, 24-72 hours, 3-7 days, 1 week-1 month, and >1 month).
- Multivariate statistical analysis was used to adjust for confounding factors including age, sex, diabetes, and infarction characteristics.
Main Results:
- Operative mortality rates varied by time interval but were not significantly increased for non-emergency surgery after 72 hours.
- Mortality was 4.4% within 24 hours, 0% between 24-72 hours, 2.1% at 3-7 days, 1.4% at 1 week-1 month, and 1.9% for patients without recent infarction.
- Multivariate analysis indicated that AMI timing less than 1 month before surgery was not associated with increased mortality when adjusted for other risk factors. No significant differences in length of stay, stroke rate, or organ failure were observed.
Conclusions:
- Non-emergency surgical revascularization can be safely performed at any time after acute myocardial infarction.
- Performing CABG surgery after 72 hours post-AMI does not increase operative mortality and is associated with acceptable morbidity.
- These findings suggest flexibility in scheduling elective revascularization procedures without compromising patient safety.
Abstract:
At present no consensus exists regarding the timing of surgical revascularization after acute myocardial infarction. Patients admitted with acute myocardial infarction between January 1990 and April 1993 underwent early cardiac catheterization if they had postinfarction ischemia or positive results on a low-level exercise stress test. If indications for surgical intervention were found at the time of catheterization, patients were operated on within 1 or 2 days or were discharged and returned for the operation within 2 to 3 weeks. During this period, we performed 2175 isolated coronary artery bypass graft procedures; 23 patients were operated on within 24 hours of acute myocardial infarction with an operative mortality of 4.4%, 30 patients underwent surgery between 24 and 72 hours after infarction with no deaths, 193 patients were operated on between 3 and 7 days after infarction with an operative mortality of 2.1%, 284 patients underwent revascularization between 1 week and 1 month after infarction with an operative mortality of 1.4%, and the 1645 patients without a recent infarction had a mortality rate of 1.9%. Multivariate statistical analysis was performed to evaluate mortality with these independent variables: reoperative surgery, sex, age, diabetes, timing of infarction, location of infarction, and type (transmural versus subendocardial). Myocardial infarction at any time interval less than 1 month before the operation was not associated with mortality when adjusted by these other risk factors. In addition, no differences were noted in length of stay, stroke rate, or prevalence of renal failure or pulmonary insufficiency. We conclude that nonemergency surgical revascularization can be done safely at any time interval after acute myocardial infarction, certainly after 72 hours, with no increase in operative mortality and acceptable morbidity.