In-Hospital Outcome of Acute Myocardial Infarction: Culprit PCI and Consecutive CABG versus Emergent Complete Surgical Revascularization

Background: Coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are standard therapeutic approaches for cardiac revascularization. The selection of therapy depends primarily on the complexity of coronary artery disease and urgency of treatment. Surgical revascularization guaranties excellent long-term outcomes in patients with advanced multivessel disease, whereas percutaneous coronary intervention of the culprit lesion is recommended in the setting of ST elevation myocardial infarction (STEMI). Still, the outcome of CABG when compared with PCI in an emergency setting is unclear.

Method: Data from January 2010 to February 2020 were used for this survey. A total of 1,062 patients with an acute myocardial infarction (STEMI: n = 229, NSTEMI: n = 883) were surgically treated (<48 hours after diagnosis) and retrospectively analyzed. In-hospital outcome (MACCE: myocardial infarction, surgical revision, stroke, and all causes of death) was compared between patients with a culprit PCI and consecutive CABG (group 1: n = 138) to patients with emergent complete surgical revascularization (group 2: n = 924). Outcome parameters were adjusted using regression analysis.

Results: There was no significant difference in terms of MACCE events between the two groups. Patient cohorts were comparable in terms of 30-day mortality (OR: 0.612, 95% CI: 0.989–1.909; p = 0.379), rate of prolonged ventilation (>24 hours); (OR: 1.161, 95% CI: 0.507– 2.660; p = 0.724), prolonged catecholamine requirement (>24 hours), (OR: 1.001, 95% CI: 0.427–2.347; p = 0.998), and secondary myocardial infarctions (OR: 1.537, 95% CI: 0.334–7.073; p = 0.581).

Conclusion: Emergent surgical revascularization is a valid and safe alternative for patients with an acute myocardial infarction. The surgical treatment offers complete revascularization with well documented long-term benefit. Whether or not this is particularly applicable for this cohort needs to be determined in a longer follow-up period and in prospective, randomized trials.

Publication History

Article published online:
28 January 2023