Revascularization after acute myocardial infarction.
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.
Creswell
L L
LL
Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
Moulton
M J
MJ
Cox
J L
JL
Rosenbloom
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001026:Coronary Artery Bypass / Q000401:mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome