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Netherlands Heart Journal

, Volume 18, Issue 7, pp 348–354 | Cite as

Role of coronary artery bypass grafting during the acute and subacute phase of ST-elevation myocardial infarction

  • Y. L. Gu
  • I. C. C. van der Horst
  • Y. L. Douglas
  • T. Svilaas
  • M. A. Mariani
  • F. Zijlstra
Original article
Coronary Artery Bypass Grafting;  Myocardial Infarction;  Treatment Outcome  

Abstract

Background/Objectives. We aimed to investigate the incidence and clinical outcome of coronary artery bypass grafting (CABG) performed in contemporary patients with ST-elevation myocardial infarction (STEMI) within 30 days after presentation.

Methods. All 1071 patients enrolled in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) were included in this analysis. CABG was indicated for both ischaemic and anatomical reasons according to the current treatment guidelines for STEMI. For all surgical as well as non-surgical patients, clinical outcome was assessed at both 30 days and one year.

Results. CABG was performed within 30 days of presentation in 59/1071 (5.5%) patients, in 13 (22%) within 24 hours, in eight (14%) between one and three days, and in 38 (64%) between four and 30 days. Compared with non-surgical patients, surgical patients required more initial intra-aortic balloon pump support (33 vs. 5%, p<0.001) and more often had multi-vessel disease (p<0.001). Overall, rethoracotomy was performed in 9/59 (15%) patients. In patients operated within three days, the rethoracotomy rate was markedly higher than after three days (33 vs. 5%, p=0.004). Cardiac mortality at 30 days and one year was 1.7% in the surgical group and 3.2 and 5.3%, respectively, in the non-surgical group.

Conclusion. STEMI patients treated with CABG within three days after presentation are at increased risk of rethoracotomy. However, despite this higher incidence of surgical complications and multiple high-risk features at presentation, surgical management during the acute and subacute phase is associated with excellent 30-day and one-year survival. (Neth Heart J 2010;18:348-54.)

References

  1. 1.
    De Luca G, Suryapranata H, Zijlstra F, van 't Hof AW, Hoorntje JC, Gosselink AT, et al. Symptom-onset-to-balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol. 2003;42:991-7.Google Scholar
  2. 2.
    Kalla K, Christ G, Karnik R, Malzer R, Norman G, Prachar H, et al. Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry). Circulation. 2006;113:2398-405.Google Scholar
  3. 3.
    Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003;361:13-20.Google Scholar
  4. 4.
    Zijlstra F, Hoorntje JC, de Boer MJ, Reiffers S, Miedema K, Ottervanger JP, et al. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med. 1999;341:1413-9.Google Scholar
  5. 5.
    Eagle KA, Guyton RA, Davidoff R, Edwards FH, Ewy GA, Gardner TJ, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation. 2004;110:e340-e437.Google Scholar
  6. 6.
    Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation. 2004;110:e82-292.Google Scholar
  7. 7.
    Stone GW, Brodie BR, Griffin JJ, Grines L, Boura J, O'Neill WW, et al. Role of cardiac surgery in the hospital phase management of patients treated with primary angioplasty for acute myocardial infarction. Am J Cardiol. 2000;85:1292-6.Google Scholar
  8. 8.
    Svilaas T, Vlaar PJ, van der Horst IC, Diercks GF, de Smet BJ, van den Heuvel AF, et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med. 2008;358:557-67.Google Scholar
  9. 9.
    Vlaar PJ, Svilaas T, van der Horst IC, Diercks GF, Fokkema ML, de Smet BJ, et al. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet. 2008;371:1915-20.Google Scholar
  10. 10.
    Seshadri N, Whitlow PL, Acharya N, Houghtaling P, Blackstone EH, Ellis SG. Emergency coronary artery bypass surgery in the contemporary percutaneous coronary intervention era. Circulation. 2002;106:2346-50.Google Scholar
  11. 11.
    Yang EH, Gumina RJ, Lennon RJ, Holmes DR, Jr., Rihal CS, Singh M. Emergency coronary artery bypass surgery for percutaneous coronary interventions: changes in the incidence, clinical characteristics, and indications from 1979 to 2003. J Am Coll Cardiol. 2005;46:2004-9.Google Scholar
  12. 12.
    Vlaar PJ, Svilaas T, Damman K, de Smet BJ, Tijssen JG, Hillege HL, et al. Impact of pretreatment with clopidogrel on initial patency and outcome in patients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a systematic review. Circulation. 2008;118:1828-36.Google Scholar
  13. 13.
    Zijlstra F, Ernst N, de Boer MJ, Nibbering E, Suryapranata H, Hoorntje JC, et al. Influence of prehospital administration of aspirin and heparin on initial patency of the infarct-related artery in patients with acute ST elevation myocardial infarction. J Am Coll Cardiol. 2002;39:1733-7.Google Scholar
  14. 14.
    Every NR, Maynard C, Cochran RP, Martin J, Weaver WD. Characteristics, management, and outcome of patients with acute myocardial infarction treated with bypass surgery. Myocardial Infarction Triage and Intervention Investigators. Circulation. 1996;94:II81-II86.Google Scholar
  15. 15.
    Karthik S, Grayson AD, McCarron EE, Pullan DM, Desmond MJ. Reexploration for bleeding after coronary artery bypass surgery: risk factors, outcomes, and the effect of time delay. Ann Thorac Surg. 2004;78:527-34.Google Scholar
  16. 16.
    Chu MW, Wilson SR, Novick RJ, Stitt LW, Quantz MA. Does clopidogrel increase blood loss following coronary artery bypass surgery? Ann Thorac Surg. 2004;78:1536-41.Google Scholar
  17. 17.
    Singh M, Nuttall GA, Ballman KV, Mullany CJ, Berger PB, Holmes DR, Jr., et al. Effect of abciximab on the outcome of emergency coronary artery bypass grafting after failed percutaneous coronary intervention. Mayo Clin Proc. 2001;76:784-8.Google Scholar
  18. 18.
    Englberger L, Faeh B, Berdat PA, Eberli F, Meier B, Carrel T. Impact of clopidogrel in coronary artery bypass grafting. Eur J Cardiothorac Surg. 2004;26:96-101.Google Scholar
  19. 19.
    Dunning J, Versteegh M, Fabbri A, Pavie A, Kolh P, Lockowandt U, et al. Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg. 2008;34:73-92.Google Scholar
  20. 20.
    Applebaum R, House R, Rademaker A, Garibaldi A, Davis Z, Guillory J, et al. Coronary artery bypass grafting within thirty days of acute myocardial infarction. Early and late results in 406 patients. J Thorac Cardiovasc Surg. 1991;102:745-52.Google Scholar
  21. 21.
    Creswell LL, Moulton MJ, Cox JL, Rosenbloom M. Revascularization after acute myocardial infarction. Ann Thorac Surg. 1995;60:19-26.Google Scholar
  22. 22.
    Lee DC, Oz MC, Weinberg AD, Ting W. Appropriate timing of surgical intervention after transmural acute myocardial infarction. J Thorac Cardiovasc Surg. 2003;125:115-9.Google Scholar
  23. 23.
    Weiss ES, Chang DD, Joyce DL, Nwakanma LU, Yuh DD. Optimal timing of coronary artery bypass after acute myocardial infarction: a review of California discharge data. J Thorac Cardiovasc Surg. 2008;135:503-11, 511.Google Scholar
  24. 24.
    Thielmann M, Neuhauser M, Marr A, Herold U, Kamler M, Massoudy P, et al. Predictors and outcomes of coronary artery bypass grafting in ST elevation myocardial infarction. Ann Thorac Surg. 2007;84:17-24.Google Scholar

Copyright information

© Bohn Stafleu van Loghum 2010

Authors and Affiliations

  • Y. L. Gu
    • 1
    • 2
  • I. C. C. van der Horst
  • Y. L. Douglas
  • T. Svilaas
  • M. A. Mariani
  • F. Zijlstra
  1. 1.Department of CardiologyUniversity Medical Center GroningenGroningenthe Netherlands
  2. 2.

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