Evaluation of coronary artery bypass grafting in acute myocardial infarction.

OBJECTIVES

We evaluated coronary artery bypass grafting (CABG) in acute myocardial infarction (AMI) within 14 days of onset.

METHODS

Of 1,450 patients undergoing isolated CABG in the last 12 years we retrospectively analyzed operative risk factors and studied the use of CABG in treating AMI in 66 undergoing surgery during the AMI phase. We divided them into 2 groups: Group D (deceased: n = 8) and Group S (survivors: n = 58).

RESULTS

Total operative mortality was 12.1% (8/66). Univariate analysis showed the following preoperative parameters to be significant in Group D: diabetes mellitus, cardiogenic shock, shortness of the interval between AMI onset and surgery, mean peak creatine phosphokinase-MB, AMI of the left main trunk, and failed recanalization of the infarcted artery. Multivariate analysis showed diabetes mellitus, cardiogenic shock, and AMI of the left main trunk as independent risk factors for hospital mortality. Intra-operative parameters between groups showed no statistical difference. Mortality in patients who did not suffer cardiogenic shock was zero.

CONCLUSION

Maintenance of hemodynamics in the early phase is vital in treating AMI. The most important element in surgical intervention is revascularization of main branches. We concluded that CABG in AMI involves relatively low risk.