Thorac Cardiovasc Surg 2017; 65(S 01): S1-S110
DOI: 10.1055/s-0037-1598764
Oral Presentations
Monday, February 13th, 2017
DGTHG: Coronary Heart Disease: Acute Myocardial Ischemia and Medical Therapy
Georg Thieme Verlag KG Stuttgart · New York

Short- and Long-Term Outcome of Patients with Acute Myocardial Infarction and Coronary Artery Bypass Surgery within 48 Hours

C. Grothusen
1   Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
C. Friedrich
1   Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
J. Loehr
1   Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
J. Meinert
1   Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
E. Ohnewald
1   Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
U. Ulbricht
1   Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
T. Attmann
1   Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
A. Haneya
1   Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
K. Huenges
1   Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
J. Cremer
1   Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
,
J. Schoettler
1   Universitätsklinikum Schleswig-Holstein - Campus Kiel, Kiel, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
03 February 2017 (online)

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Objectives: Timing of coronary artery bypass surgery (CABG) in patients with acute myocardial infarction (AMI) and coronary artery disease not amendable for percutaneous treatment remains a controversially discussed topic. We here report our experience with CABG within 48 hours after AMI.

Methods: Between 01/2001 and 05/2015, 766 patients with either ST-elevation myocardial infarction (STEMI, N = 305, 40%) or Non-STEMI (N = 461, 60%) underwent CABG within 48 hours.

Results: STEMI patients were significantly younger (65 [58; 72] vs. 70 [62; 75] years, p < 0.001) with a lower EuroScore II (4.12 [2.75; 5.81] vs. 4.58 [2.80; 7.74], p = 0.009). STEMI patients had more often undergone percutaneous transluminal angioplasty (PTCA) prior to surgery (20.4 vs. 7.8%, p < 0.001). Time from AMI to surgery was significantly shorter in individuals with STEMI compared with NSTEMI (5.0 [3.2; 8.8] vs. 11.7 [6.4; 22.0] hours, p < 0.001). Coronary angiography demonstrated coronary 3-vessel disease more frequently in NSTEMI than STEMI patients (86.9 vs. 80.2%, p = 0.014). No significant differences concerning operation duration (212 [184; 248] vs. 214 [187; 247] min, p = 0.419), arterial graft use (93.8 vs. 94.8%, p = 0.540) or complete revascularization (87.5 vs. 83.4%, p = 0.121) was observed. The rate of peri-operative strokes did not differ between the groups (2.0 vs. 3.9%, p = 0.134). 30-day mortality was significantly higher in patients with NSTEMI (6.6 vs. 2.7%), p = 0.018), especially when CABG was performed within 6 hours (7.1 vs. 1.8%, p = 0.041). Overall, survival of STEMI and NSTEMI patients was 94% versus 88% after 1 (p < 0.001), 87 versus 73% after 5 (p < 0.001), and 74 versus 57% after 10 years, respectively. Preoperative atrial fibrillation (AF), and lactate levels (LL) exceeding 2 mmol/L were independent predictors of both, 30-day (AF: OR 5.48; p < 0.001; LL: OR 3.59; p = 0.006) and long-term mortality (AF, HR 2.27, p < 0.001; LL HR 1.88, p = 0.004) .

Conclusion: Compared with individuals with STEMI, patients with NSTEMI showed a reduced survival after CABG performed within 48 hours. Pre-operative atrial fibrillation and lactate Levels were independent predictors of short - as well as long-term mortality in this specific patient population.