Cirurgia de revascularização na fase aguda do infarto do miocárdio: análise dos fatores pré-operatórios preditores de mortalidade

Abstract

M a i l i n g A d d r e s s : OBJECTIVETo assess preoperative predictors of mortality in patients undergoing coronary artery bypass grafting (CABG) within the first 30 days of acute myocardial infarction (AMI). METHODSBetween March 1998 and July 2002, 753 AMI patients were consecutively and prospectively entered into a database, 135 (17.9%) of whom underwent isolated CABG and were enrolled in this study. The following prognostic factors were assessed by multivariate analysis: age, gender, diabetes, history of previous AMI, CABG or coronary angioplasty (PTCA), anterior infarct location, Q-wave AMI, the use of fibrinolytics, elapsed time from AMI to the procedure, and presence of complications in the preoperative period. RESULTSOverall in-hospital mortality was 6.7%, ranging from 12.5% in patients with preoperative complications to 1.4% in those with no complications. Only history of previous angioplasty (p = 0.037) and cardiogenic shock (p = 0.002) showed a statistically significant correlation with postoperative mortality. The use of thrombolytics, on the other hand, in the initial management of AMI showed a negative correlation with mortality (p = 0.035). CONCLUSIONCABG in the acute phase of MI is associated with distinct operative mortality, depending on the patient's preoperative clinical condition. Among those factors analyzed, preoperative cardiogenic shock and history of previous angioplasty were predictive of worse prognosis in this group of patients. KEY WORDSmortality, surgery, acute myocardial infarction.

Preditores de mortalidade em pacientes acima de 70 anos na revascularização miocárdica ou troca valvar com circulação extracorpórea

“…But he noted that these variables did not show differences in mortality in this group of patients [15].…”

Optimal Timing of Surgical Revascularization for Myocardial Infarction and Left Ventricular Dysfunction

“…and Ladeira et al . [ 17 18 ] These investigators prospectively analyzed 4090 patients who underwent CABG after MI and divided them into three groups based on the MI-to-CABG intervals of 0–30 days, 31–90 days, and >90 days. Their 5-year survival rates were 85.5%, 85.2%, and 89.3%, respectively, with no significant difference among the three groups.…”

“…[ 13 14 15 ] Although the latest American College of Cardiology (ACC)/American Heart Association guidelines for CABG surgery provided specific recommendations for surgical revascularization after STEMI, the optimal timing of CABG after AMI is still not well defined according to previous studies. [ 16 17 18 19 ] Some studies recommended that an interval of at least 1 week between STEMI and surgical revascularization was relatively safe. [ 20 ] However, other studies have demonstrated that CABG can be performed at any time after STEMI.…”