Treatment strategies for ST-elevation myocardial infarction (STEMI) have undergone great evolution since introduction of acute percutaneous coronary intervention (PCI) therapy. The purpose was therefore to evaluate in-hospital mortality, clinical outcomes, and predictors of survival among patients who underwent surgical revascularization with coronary artery bypass grafting (CABG) due to STEMI unresponsive to maximal non-surgical therapy.
Between 01/2000 and 01/2005 eighty-four patients underwent CABG due to STEMI at our institution. Preoperative, intraoperative and postoperative data were recorded prospectively. In-hospital mortality, major adverse cardiac events (MACE), and other clinical outcomes were investigated retrospectively.
Thirty-four, 22, 10, and 18 among 84 patients with STEMI underwent CABG within 6 hours (hrs), 7-24 hrs, 1-3 days, and 4-7 days from onset of symptoms to surgery, respectively. Thirty-two among 84 (38%) patients were admitted to surgery complicated by preoperative cardiogenic schock. Thus, preoperative and/or intraoperative intraaortic balloon counterpulsation was performed in 15 and 45 patients, whereas preoperative extracorporeal membrane oxygenation was necessary in 2 patients. Mean number of grafts per patient was 3.1±0.9. Aortic cross-clamp time, cardiopulmonary bypass time, and reperfusion time were 67±21 min and 126±45 min, and 46±22 min, respectively. Ventilation time, ICU and hospial stay were 54±53 hrs (mean±SD), 6.3±6.4 hrs and 21±24 days, respectively. Overall in-hospital mortality was 13.1%. On multivariate logistic regression analysis, gender (Odds ratio [OR]: 8.7, 95% confidence interval [CI]: 1.2-62.5), the level extent of preoperative cardiac troponin I (OR: 1.2,CI: 1.1-1.4), and time from onset of symptoms to surgery (OR: 1.1,CI: 1.1-2.8) were independent predictors of in-hospital death.
Emergency CABG in STEMI patients unresponsive to maximal non-surgical therapy can be performed with acceptable risk incorporating adequate management strategies.
The extent of acute myocardial damage and time period from symptoms to surgery are major variables predicting mortality results and thus, may help the surgeon to decide about the appropriate timing of surgical revascularization in patients with acute STEMI.
Matthias Thielmann, None.