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Early and late outcome after CABG in patients with evolving myocardial infarction
P Sergeant1, E Blackstone, B Meyns
1Cardiac Surgery Department, Gasthuisberg University Hospital Leuven, Belgium. Paul.Sergeant@uz.kuleuven.ac.be
Insights
Coronary artery bypass grafting (CABG) for evolving myocardial infarction offers acceptable early and long-term survival, even in unstable patients. Graft choice, including internal mammary artery, did not impact outcomes.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Myocardial Infarction Management
Background:
- Evolving myocardial infarction presents significant challenges for surgical intervention.
- Coronary artery bypass grafting (CABG) is a critical treatment option for these patients.
- Understanding determinants of early and late outcomes is essential for patient selection and management.
Purpose of the Study:
- To investigate factors influencing early and late outcomes following CABG in patients with evolving myocardial infarction.
- To assess the impact of hemodynamic status on surgical results.
- To evaluate the role of internal mammary artery (IMA) grafts in this patient population.
Main Methods:
- A cohort of 269 patients undergoing isolated primary or repeat CABG for evolving myocardial infarction between 1971 and 1992.
- Patients were stratified into hemodynamic classes: stable, cardiogenic shock, and cardiopulmonary resuscitation (CPR).
- Follow-up was 100% complete, with multivariable analysis conducted using hazard function models.
Main Results:
- One, one, and ten-year survival rates were 86%, 84%, and 66%, respectively.
- Patients in stable condition had superior survival rates (1-year: 98%, 10-year: 77%) compared to those in shock or undergoing CPR.
- Cardiogenic shock and CPR were identified as risk factors for early mortality, but not late mortality. IMA graft use showed no significant impact on outcomes.
Conclusions:
- CABG can be safely performed in selected patients with evolving myocardial infarction, irrespective of their hemodynamic status.
- The choice of bypass conduit, including IMA grafts, does not appear to influence early or late survival.
- Patients with evolving myocardial infarction and stable hemodynamics experience a lower risk profile compared to those with unstable angina and ST-segment changes.
Objective:
To study the determinants of early and late outcome after coronary artery bypass grafting (CABG) for evolving myocardial infarction.
Method:
269 consecutive patients underwent isolated primary or repeat CABG from 1971 to 1992 for evolving myocardial infarction. By institutional policy, these were patients, strictly diagnosed, infarcting either in the cardiac cateterization laboratory, shortly after a previous CABG, or on cardiac intervention waiting lists. At operation, 125 patients were hemodynamically stable, 89 patients in cardiogenic shock 55 patients in cardiopulmonary resuscitation (CPR). Interval between infarct onset and surgical reperfusion ranged from 53 min to 15 h (median, 135 min; 90% between 75 and 360). An internal mammary artery graft (IMA) was used in 81 patients. Cross-sectional follow-up was 100% complete and multivariable analysis was conducted in the hazard function domain.
Result:
One-month, 1-year and 10-year survival was 86, 84 and 66%, respectively. The 1-year and 10-year survival, stratified by hemodynamic class, was respectively 98 and 77% for the stable patients, 77 and 60% for the patients in shock and 62 and 49% for those undergoing CPR. Shock and CPR were incremental risk factors for early but not late risk. Use of an IMA graft was not a risk factor early or late in either stable or unstable patients.
Conclusion:
CABG can be performed with acceptable early and long-term risk in selected patients with evolving myocardial infarction, whatever their hemodynamic state. Outcome as regards survival is neither adversely or advantageously affected by choice of bypassing conduit. An evolving myocardial infarction with stable hemodynamics carries a lesser risk than an unstable anginal state with changing ST-segment.