Division of Cardiovascular Surgery, Ilsan Hospital, Go-Yang, South Korea.
Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea.
Clin Cardiol. 2024 Aug;47(8):e24325. doi: 10.1002/clc.24325.
Acute myocardial infarction (AMI) is a major global health concern. However, the optimum timing of coronary artery bypass grafting (CABG) in AMI patients remains controversial. This study investigated the optimal timing of CABG and its impact on postoperative outcomes. We hypothesized that determining the optimal timing of CABG could positively impact postoperative outcomes.
We conducted a nationwide retrospective analysis of the National Health Insurance Service of Korea database, focusing on 1 705 843 adult AMI patients diagnosed between 2007 and 2018 who underwent CABG within 1 year of diagnosis. Patients were categorized based on CABG timing. Primary endpoints included cohort identification and the time interval from AMI diagnosis to CABG. Secondary endpoints encompassed major adverse cardiac and cerebrovascular events (MACCEs) and the impact of postoperative medications.
Of the patients, 20 172 underwent CABG. Surgery within 24 h of AMI diagnosis demonstrated the most favorable outcomes, reducing cardiac death, myocardial infarction recurrence, and target vessel revascularization. Delayed CABG within 3 days also outperformed surgery within 1-2 days post-AMI. Additionally, postoperative aspirin use was associated with improved MACCE outcomes.
CABG within 24 h of AMI diagnosis was associated with significantly minimized myocardial injury, emphasizing the critical role of rapid revascularization. Delayed CABG within 3 days related to better outcomes compared with that of surgery within 1-2 days. These findings provide evidence-based recommendations for optimizing CABG timing in AMI patients, consequentially reducing morbidity and mortality.
急性心肌梗死（AMI）是一个全球性的主要健康问题。然而，AMI 患者行冠状动脉旁路移植术（CABG）的最佳时机仍存在争议。本研究旨在探讨 CABG 的最佳时机及其对术后结果的影响。我们假设确定 CABG 的最佳时机可以对术后结果产生积极影响。
我们对韩国国家健康保险服务数据库进行了全国性回顾性分析，研究对象为 2007 年至 2018 年间诊断为 AMI 且在诊断后 1 年内接受 CABG 的 1705843 名成年 AMI 患者。根据 CABG 的时机对患者进行分类。主要终点包括队列识别和从 AMI 诊断到 CABG 的时间间隔。次要终点包括主要不良心脏和脑血管事件（MACCE）以及术后药物治疗的影响。
在患者中，有 20172 人接受了 CABG。AMI 诊断后 24 小时内进行手术的结果最佳，降低了心脏性死亡、心肌梗死复发和靶血管血运重建的发生率。AMI 后 3 天内延迟 CABG 也优于 1-2 天内的手术。此外，术后使用阿司匹林与改善 MACCE 结果相关。
AMI 诊断后 24 小时内进行 CABG 与显著最小化的心肌损伤相关，强调了快速血运重建的关键作用。与 1-2 天内手术相比，AMI 后 3 天内延迟 CABG 相关的结果更好。这些发现为优化 AMI 患者 CABG 时机提供了循证建议，从而降低发病率和死亡率。
