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

Wang, Rong; Cheng, Nan; Xiao, Cang-song; Wu, Yaling; Sai, Xiaoyong; Gong, Zhiyun; Wang, Yao; Gao, Changqing

doi:10.4103/0366-6999.199847

Cited by 6 publications

(4 citation statements)

References 31 publications

(41 reference statements)

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“…Based on these arbitrary cut-off points different studies have tried to create different cohorts and have arrived at different conclusions. The cut-off time points at which these various comparisons have been made are 1 day [ 13 ], 2 days [ 6 ], 3 days [ 8 ], 7 days [ 13 ], 10 days [ 16 ], 14 days [ 12 ], 3 weeks [ 17 ], and 6 weeks [ 14 ]. While there is a general acceptance that a longer gap between MI and CABG reduces the risk, it appears that it is difficult if not impossible to come to a consensus over the ideal cut-off time for CABG.…”

Section: Discussionmentioning

confidence: 99%

Timing of coronary artery bypass grafting after acute myocardial infarction: does it influence outcomes?

Thilak¹,

Thacker²,

Shales³

et al. 2021

kitp

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Introduction: The optimal timing of coronary artery bypass grafting (CABG) operations in patients with recent acute myocardial infarction (AMI) remains unclear. Aim: To assess the influence of timing on post-operative outcomes in patients undergoing CABG following AMI. Material and methods: In this retrospective analysis 12,224 consecutive patients undergoing CABG were included. 2477 (20.5%) patients had a history of AMI. Based on timing, patients were divided into 3 groups: those operated within 7 days of AMI; those operated after 7 days but within 1 month; and a third group operated after 1 month but within 3 months. The 3 groups were compared in terms of baseline, intra-operative, and post-operative morbidity and mortality. Multivariate analysis was carried out to assess the independent influence of timing of CABG on outcomes. Results: There was no difference in terms of previous neurological events (p = 0.554), presence of carotid artery disease (p = 0.555), prevalence of hypertension (p = 0.119), diabetes (p = 0.144), hypothyroidism (p = 0.53), chronic obstructive pulmonary disease (p = 0.079), peripheral vascular disease (p = 0.771), and impaired left ventricular function (p = 0.072). On univariate analysis, mortality risk was highest between 1 week and 1 month (p = 0.003). Multivariate analysis showed that the closer the MI and CABG duration, the higher the mortality (co-efficient -0.517; p = 0.019; odds ratio = 0.596; 95% CI: 0.388-0.917). Conclusions: The duration between MI and CABG has a direct influence on outcomes after CABG. While it is clear that the longer the duration between MI and CABG, the lower the mortality risk, it is however difficult to decide on an exact cut-off time frame.

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Section: Discussionmentioning

confidence: 99%

Timing of coronary artery bypass grafting after acute myocardial infarction: does it influence outcomes?

Thilak¹,

Thacker²,

Shales³

et al. 2021

kitp

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“…На основании их результатов можно сделать вывод, что операция может быть безопасно проведена в любой момент времени через 6 ч после события без увеличения госпитальной смертности. Однако следует учитывать, что претендентами на проведение экстренной операции АКШ, выполняемой в первые часы, зачастую являются пациенты крайне высокого риска, когда отсрочка выполнения операции невозможна, и высокие показатели периоперационной летальности в этой группе больных ожидаемы [33,34].…”

Section: акш у пациентов с оксбпStunclassified

“…Таким образом, по мнению авторов, стратегия ожидания, позволяющая миокарду восстановиться, оправданна. Мнения, что отсрочка в проведении АКШ при ИМбпST способствует снижению пери операционного риска, придерживаются и ряд авторов [33,34]. Однако необходимо понимать, что отсрочка в выполнении реваскуляризации далеко не всегда целесообразна, а в ряде случаев и невозможна.…”

Section: акш у пациентов с оксбпStunclassified

Coronary artery bypass grafting in the treatment of patients with acute coronary syndrome: current evidence base and unresolved issues

2021

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The issue of the optimal timing of coronary artery bypass grafting (CABG) in acute coronary syndrome (ACS) remains controversial. It is known that on the one hand there will be a delay in revascularization, leading to recurrent myocardial infarction with irreversible cardiac dysfunction. On the other hand, there is an increased incidence of perioperative complications associated with surgery.This article provides a detailed analysis of the evidence base and current guidelines on the validity and timing of coronary artery bypass grafting in various types of ACS. The emphasis is made on the contradictions regarding the earlier implementation of the active strategy in non-ST segment elevation ACS. We describe problem of insufficient evidence base on optimal timing of CABG, comparison of outcomes of percutaneous coronary intervention (PCI) performed in the first 24 hours and open surgery for high-risk non-ST segment elevation ACS, as well as a number of organizational and clinical issues to ensure the surgery availability.

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“…При оперативном лечении по поводу трансмурaльного инфаркта с нарушениями гемoдинамики летальность достигает 30-50 % и остается повышенной в ближайшие 1,5 мес. [6]. Реваскуляризация миокарда при диагностической КАГ допускается лишь при изолированных поражениях, по которым есть междисциплинарные протоколы с ориентацией на исследования SYNTAX.…”

Section: краткие сообщения введениеunclassified

Aortocoronary Bypass Surgery in Patients with Recurrent Post-Coronary Stenting Angina

Valieva

Мультановский

Сибгатуллин

2021

Kreativnaâ hirurgiâ i onkologiâ

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Background. A wide adoption of percutaneous coronary operations has led to an average one-third reduction in the aortocoronary bypass surgery (ACB) rate and altering of the ACB patient profile to mainly represent advanced occlusive coronary atherosclerosis.Materials and methods. The study analyses treatment outcomes in coronary heart disease patients with recurrent angina after a previous endovascular intervention. Over years 2009–2015, 1,023 ACB operations were performed at the Almetyevsk — OAO Tatneft Medical Unit cardiac surgery rooms. Pre-surgery coronary artery stenting (CAS) was rendered at various terms in 96 patients (23 % women, 76 % men; cohort 1). The main cohort (n = 96) was divided into 2 subgroups: IA (n = 64), single CAS; IB (n = 32), multiple CAS patients. For statistical significance, cohort 2 (control) comprised 185 patients (21 % women, 79 % men) to include every 5th history of the remaining 927 patients operated within same period.Results and discussion. The mean aortic occlusion time was shorter in multiple CAS patients vs. other cohorts (61.3 ± 31.2 vs. 72.5 ± 27.8 and 70.7 ± 41.2 min). Cohort 1 had an overall higher emergency resternotomy rate due to ongoing bleeding (7.4 and 8.3 vs. 2.0 %). Furthermore, pre-surgery multiple CAS patients more likely faced the complications of perioperative MI (8.5 vs. 3.1 and 1.4 %) and acute postoperative heart failure (7.2 vs. 2.3 and 1.4 %, p < 0.01). This cohort often required inotropic support (9.3 vs. 3.8 and 2.1 %).Conclusion. Statistical analysis revealed a significantly higher complication and mortality rate in patients with previous coronary stenting compared to ACB patients. Adverse ACB outcomes were observed with multiple-coronary stenting cases, in contrast to the cohort with no pre-surgery interventions.

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

Cited by 6 publications

References 31 publications

Timing of coronary artery bypass grafting after acute myocardial infarction: does it influence outcomes?

Timing of coronary artery bypass grafting after acute myocardial infarction: does it influence outcomes?

Coronary artery bypass grafting in the treatment of patients with acute coronary syndrome: current evidence base and unresolved issues

Aortocoronary Bypass Surgery in Patients with Recurrent Post-Coronary Stenting Angina

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