Revascularization after acute myocardial infarction

Lawrence L. Creswell, Michael J. Moulton, James L. Cox, Michael Rosenbloom

Research output: Contribution to journalArticle

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Abstract

Background.: The optimal timing for coronary artery bypass grafting (CABG) after acute myocardial infarction (MI) remains controversial. Methods.: We examined our experience retrospectively in 3,942 patients who underwent CABG between 1986 and 1993, including 2,296 patients after acute MI. Results.: The operative mortality associated with increasing time intervals between MI and CABG were 9.1%, 8.3%, 5.2%, 6.5%, and 2.9%, for less than 6 hours, 6 hours to 2 days, 2 to 14 days, 2 to 6 weeks, and more than 6 weeks, respectively. In comparison, the operative mortality was 2.5% for patients with no history of acute MI. The incidence of permanent stroke and perioperative MI were greater and the length of postoperative hospitalization was longer for patients undergoing CABG early after MI. For patients undergoing operation electively, however, the operative mortality associated with increasing time intervals between MI and CABG were less, at 0.0%, 3.6%, 2.1%, 6.4%, and 2.1% for less than 6 hours, 6 hours to 2 days, 2 to 14 days, 2 to 6 weeks, and more than 6 weeks, respectively. For patients undergoing CABG within 14 days of MI, the operative mortality was 5.3% for those receiving an intraaortic balloon pump preoperatively for postinfarction angina, but 11.8% for those who underwent urgent/emergent operation without intraaortic balloon pump support. Conclusions.: Elective CABG can be accomplished with acceptable morbidity and mortality early after acute MI if an elective operation is possible. In addition, the intraaortic balloon pump should be used aggressively in patients with postinfarction angina to allow for elective rather than urgent/emergent operation.

Original languageEnglish (US)
Pages (from-to)19-26
Number of pages8
JournalThe Annals of Thoracic Surgery
Volume60
Issue number1
DOIs
StatePublished - Jul 1995

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Coronary Artery Bypass
Myocardial Infarction
Mortality
Hospitalization
Stroke
Morbidity
Incidence

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Revascularization after acute myocardial infarction. / Creswell, Lawrence L.; Moulton, Michael J.; Cox, James L.; Rosenbloom, Michael.

In: The Annals of Thoracic Surgery, Vol. 60, No. 1, 07.1995, p. 19-26.

Research output: Contribution to journalArticle

Creswell, Lawrence L. ; Moulton, Michael J. ; Cox, James L. ; Rosenbloom, Michael. / Revascularization after acute myocardial infarction. In: The Annals of Thoracic Surgery. 1995 ; Vol. 60, No. 1. pp. 19-26.
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abstract = "Background.: The optimal timing for coronary artery bypass grafting (CABG) after acute myocardial infarction (MI) remains controversial. Methods.: We examined our experience retrospectively in 3,942 patients who underwent CABG between 1986 and 1993, including 2,296 patients after acute MI. Results.: The operative mortality associated with increasing time intervals between MI and CABG were 9.1{\%}, 8.3{\%}, 5.2{\%}, 6.5{\%}, and 2.9{\%}, for less than 6 hours, 6 hours to 2 days, 2 to 14 days, 2 to 6 weeks, and more than 6 weeks, respectively. In comparison, the operative mortality was 2.5{\%} for patients with no history of acute MI. The incidence of permanent stroke and perioperative MI were greater and the length of postoperative hospitalization was longer for patients undergoing CABG early after MI. For patients undergoing operation electively, however, the operative mortality associated with increasing time intervals between MI and CABG were less, at 0.0{\%}, 3.6{\%}, 2.1{\%}, 6.4{\%}, and 2.1{\%} for less than 6 hours, 6 hours to 2 days, 2 to 14 days, 2 to 6 weeks, and more than 6 weeks, respectively. For patients undergoing CABG within 14 days of MI, the operative mortality was 5.3{\%} for those receiving an intraaortic balloon pump preoperatively for postinfarction angina, but 11.8{\%} for those who underwent urgent/emergent operation without intraaortic balloon pump support. Conclusions.: Elective CABG can be accomplished with acceptable morbidity and mortality early after acute MI if an elective operation is possible. In addition, the intraaortic balloon pump should be used aggressively in patients with postinfarction angina to allow for elective rather than urgent/emergent operation.",
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