Timing of coronary artery bypass grafting following acute myocardial infarction

Abstract

Objective: There is wide variations in practice about the exact timing of coronary artery bypass grafting (CABG) post-acute myocardial infarction (AMI) and admission to hospital. This study aims to review current literature evidence to provide an up-to-date evaluation of the optimal CABG timing and parameters indicative of patient outcomes. Method: Electronic literature search was done to look into articles that discussed acute myocardial presentation and their referral for CABG either as urgent in-patient or as elective cases. The evidence was synthesised based on each reported article and their outcomes. Results: The timing of CABG following AMI have been explored in multiple studies, however there is no clear consensus on when to proceed with CABG following AMI and this remains controversial. The mortality rates vary with timing of CABG, but confounding factors such as age, poor pulmonary functions, renal insufficiency, poor left ventricular function and many others can all contribute to the variable reported outcomes. Conclusion: There is need for large, multi-centre study to identify optimal timings for CABG in cases of complex coronary artery diseases or failed PCI in patients with acute MI. Upcoming guidelines should emphasize patient cohorts by taking their risk factors into consideration.