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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.

The Journal of Thoracic and Cardiovascular Surgery
|May 1, 1994
PubMed
Summary

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.

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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).

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  • 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.