Timing of Coronary Artery Bypass Grafting Surgery after Acute Myocardial Infarction

Abstract

<jats:p>Background: Optimal timing for CABG surgery after myocardial infarction remains a matter of debate. The aim of our study was to analyze the effect of timing of CABG after acute myocardial infarction on operative mortality and morbidity.&#x0D; Methods: This prospective study included 60 patients who underwent isolated CABG within 30 days of acute myocardial infarction over 20 months (from the first of November 2014 till the end of June 2016) in Kasr Al-Ainy University Hospitals. Patients were divided into two groups; the early group (0 – 3 days) included 14 patients (23.3%) and the late group (4 – 30 days) included 46 patients (76.7%). The primary outcome was all-cause hospital mortality.&#x0D; Results: Our study included 43 males (71.7%) and 17 females (28.3%). The mean age was 58.4 ± 7.3 years. The total mortality rate was 8.3%. Patients undergoing early CABG experienced a higher mortality rate than those undergoing late CABG (21.4% vs 4.3%, P = 0.043). Also, early CABG was associated with more postoperative complications. Cardiogenic shock and early CABG were independent risk factors of mortality.&#x0D; Conclusion: CABG in the first 3 days after acute myocardial infarction was associated with high mortality and morbidity in comparison with late CABG. This suggests that CABG may best be deferred for more than 3 days after acute MI in non-urgent cases.</jats:p>

Comparison of On-Pump Beating Heart Surgery Versus Conventional Bypass Surgery in Patients with Acute Myocardial Infarction Requiring Urgent Revascularization

“…Off-pump beating heart coronary surgery is a preferred procedure for patients who need immediate coronary bypass surgery due to myocardial infarction. Several studies have demonstrated that off-pump beating heart surgery yields comparable cardiac outcomes to traditional CABG procedures [6][7][8][9]. Although off-pump beating heart surgery has been proven to be effective and safe when compared to conventional CABG (which is associated with side effects of CPB, problems from cross clamp usage, and cardioplegia), some opponents argue that achieving full revascularization may be challenging in the majority of off-pump patients.…”

On Pump Beating Heart Coronary Artery Surgery in Patients Requiring Urgent Revascularization

“…With advancements in myocardial protection tactics, anesthetics, and surgical procedures, CABG has become a generally safe and effective procedure. However, it is important to note that despite these improvements, there are still instances of significant mortality and morbidity rates reported in emergency traditional CABG following acute myocardial infarction (AMI) [2,12,13]. This high prevalence can be attributed to the patient's poor preoperative condition, which encompasses factors such as cardiogenic shock, organ failure, and myocardial injury resulting from cardioplegic arrest.…”