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Surgical myocardial revascularization after acute infarction
1Section of Cardiothoracic Surgery, Indiana University, Indianapolis.
Abstract:
The records of 288 patients undergoing isolated surgical myocardial revascularization between June 1989 and September 1992 were reviewed to determine the relative risk associated with surgery after an acute myocardial infarction (MI). A total of 73 patients (25 percent) were operated on within 30 days of an acute infarction while 215 patients (75 percent) had no history of recent infarction. Patients with an acute infarction were more likely to have regional wall motion abnormalities on ventriculography (mean wall score 6.7 vs 4.9, p = 0.001), require preoperative balloon pumping (15.1 percent vs 5.6 percent, p = 0.01), and have recent symptoms of congestive heart failure (23 percent vs 12 percent, p = 0.02). Patients with an acute MI also had higher NYHA functional classification and greater urgency of surgery. Despite these differences, overall mortality was lower in the acute MI group than in the control population (1.4 percent vs 2.3 percent, p = 0.623). Weaning from bypass was not appreciably more difficult in patients with an acute MI, nor were there differences in the mean number of hours of balloon pump or inotrope support.
Insights
Surgery after acute myocardial infarction (MI) is associated with increased preoperative risks but shows lower overall mortality. This study found that patients undergoing myocardial revascularization post-MI had better outcomes than controls.
Area of Science:
- Cardiology
- Cardiac Surgery
- Cardiovascular Research
Background:
- Surgical myocardial revascularization is a common procedure for coronary artery disease.
- The risks of undergoing surgery shortly after an acute myocardial infarction (MI) require careful evaluation.
Purpose of the Study:
- To determine the relative risk and outcomes of surgical myocardial revascularization performed after an acute myocardial infarction (MI).
Main Methods:
- Retrospective review of 288 patients undergoing isolated surgical myocardial revascularization.
- Comparison of outcomes between patients operated on within 30 days of acute MI (n=73) and those without recent MI (n=215).
Main Results:
- Patients with recent MI exhibited higher rates of regional wall motion abnormalities, need for preoperative balloon pumping, and congestive heart failure symptoms.
- Despite increased preoperative severity, the acute MI group had lower overall mortality (1.4% vs 2.3%).
- No significant differences were observed in weaning from bypass or duration of mechanical support.
Conclusions:
- Surgical myocardial revascularization after acute myocardial infarction is feasible and associated with favorable mortality outcomes.
- Increased preoperative risk factors in the acute MI group did not translate to poorer surgical results.