Early myocardial surgical revascularization after ST-segment elevation myocardial infarction in multivessel coronary disease: bridge therapy is the solution?

Abstract

We can conclude that a careful preoperative selection is mandatory for a good postoperative course and long-term survival and that early-staged CABG can, however, be performed using bridge therapy, also after STEMI.

Eficácia e segurança da ponte de tirofiban como alternativa à suspensão da terapia antiplaquetária dupla em pacientes submetidos à cirurgia: uma revisão sistemática

“…In two studies, 26 , 31 aspirin was only withdrawn in cases involving laparotomy. In the study by Polito et al, 30 none of the patients had aspirin suspended, whereas in Xia et al, 34 aspirin was withdrawn 5 days before surgery.…”

“…Three of the five studies analyzed were conducted in Italy, 26 , 30 , 31 one took place in Holland, 28 and one was carried out in China. 34 As can be observed in Table 2 , only the article with the largest number of patients had a control group.…”

“…There were 422 patients in the studies reviewed, 67.78% of whom underwent non-cardiac surgery. Death and MI were included in the primary outcome definition in all of the studies; ST was only listed as an outcome in two studies, 26 , 28 but was reported in the results in the other three studies; 30 , 31 , 34 revascularization of the target lesion or target-vessel was reported in two; 31 , 34 and stroke was only reported in one study. 26 Hemorrhagic events and bleeding were included in the secondary outcomes of four studies, 26 , 28 , 31 , 34 regardless of the specific definition of each of them; two of the four studies 26 , 31 used criteria from the Thrombolysis in Myocardial Infarction (TIMI) 36 study to classify them.…”

“…As shown in Table 3 , age, sex and preexisting diseases were reported in all of the studies selected, 26 , 28 , 30 , 31 , 34 Of the total of 422 patients, 325 (77%) were men and 97 (23%) were women. Comorbidities reported included 99 (23.46%) out of 422 patients with diabetes and 270 (63.98%) patients with systemic arterial hypertension (SAH).…”

“…Four of the five studies demonstrated that tirofiban bridge has efficacy for reducing adverse ischemic events, to the extent that there were no ST in three studies. 28 , 31 , 34 In the fourth, 30 just one of 21 patients had an ST. None of these four studies reported deaths, MI, re-infarction, or revascularization of the target lesion.…”