Clinical Results and Optimal Timing of OPCAB in Patients with Acute Myocardial Infarction

Youn, Young Nam; Yang, Hong Suk; Shim, Yeon Hee; Yoo, Kyung Jong

Abstract

BACKGROUND: There are a lot of debates regarding the optimal timing of operation of acute myocardial infarction (AMI). Off pump coronary artery bypass grafting (OPCAB) has benefits by avoiding the adverse effects of the cardiopulmonary bypass, but its efficacy in AMI has not been confirmed yet. The purpose of this study is to evaluate retrospectively early and mid-term results of OPCAB in patients with AMI according to transmurality and timing of operation. MATERIAL AND METHOD: Data were collected in 126 AMI patients who underwent OPCAB between January 2002 and July 2005. Mean age of patients were 61.2 years. Male was 92 (73.0%) and female was 34 (27.2%). 106 patients (85.7%) had 3 vessel coronary artery disease or left main disease. Urgent or emergent operations were performed in 25 patients (19.8%). 72 patients (57.1%) had non-transmural myocardial infarction (group 1) and 52 patients (42.9%) had transmural myocardial infarction (group 2). The incidence of cardiogenic shock and insertion of intra-aortic balloon pump (IABP) was higher in group 2. The time between occurrence of AMI and operation was divided in 4 subgroups (<1 day, 1~3 days, 4~7 days, > 8 days). OPCAB was performed a mean of 5.3+/-7.1 days after AMI in total, which was 4.2+/-5.9 days in group 1, and 6.6+/-8.3 days in group 2. RESULT: Mean distal anastomoses were 3.21 and postoperative IABP was inserted in 3 patients. There was 1 perioperative death in group 1 due to low cardiac output syndrome, but no perioperative new MI occurred in this study. There was no difference in postoperative major complication between two groups and according to the timing of operation. Mean follow-up time was 21.3 months (4~42 months). The 42 months actuarial survival rate was 94.9+/-2.4%, which was 91.4+/-4.7% in group 1 and 98.0+/-2.0% in group 2 (p=0.26). The 42 months freedom rate from cardiac death was 97.6+/-1.4% which was 97.0+/-2.0% in group 1 and 98.0+/-2.0% in group 2 (p=0.74). The 42 months freedom rate from cardiac event was 95.4+/-2.0% which was 94.8+/-2.9% in group 1 and 95.9+/-2.9% in group 2 (p=0.89).
CONCLUSION
OPCAB in AMI not only reduces morbidity but also favors hospital outcomes irrespective of timing of operation. The transmurality of myocardial infarction did not affect the surgical and midterm outcomes of OPCAB. Therefore, there may be no need to delay the surgical off-pump revascularization of the patients with AMI if surgical revascularization is indicated.