title: Emergency myocardial revascularization for acute myocardial infarction: survival benefits of avoiding cardiopulmonary bypass.
abstract: OBJECTIVE
  Emergency coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) is associated with increased operative mortality. It has been suggested that this mortality might be reduced by performing the operation without cardiopulmonary bypass (CPB).
  
  
  METHODS
  Between January 1992 and April 1998, 77 patients underwent emergency CABG within 48 h of AMI. Thirty seven were operated on with CPB, and 40 without CPB. The two groups were similar regarding age, gender, left-ventricular ejection fraction (EF) and preoperative use of intra-aortic balloon pump (IABP; 50%). The mean number of grafts/patient was 3 in the CPB group, and 1.9 in the No-CPB group (P<0.0001).
  
  
  RESULTS
  Operative mortality in the CPB group was 24% (nine of 37) compared to 5% (two of 40) without CPB (P=0.015). Follow-up ranged between 6 and 66 months. There were no late deaths in the CPB group compared to nine (22%) in the No-CPB group (P<0.0066). Patients operated on with CPB had lower rates of recurrent angina (0 versus 15%; P=0.04) and re-interventions (0 versus 15%; P=0.04).
  
  
  CONCLUSIONS
  Our experience suggests that CABG without CPB is the preferred method of myocardial revascularization, due to the fact that it carries lower mortality than CABG with CPB. The trade-off includes increased rates of recurrent angina, re-interventions and late mortality.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Tel Aviv Sourasky Medical Center, 6 Weizman St., Tel-Aviv, Israel.
authors.forename: C
authors.initials: C
authors.lastname: Locker
authors.forename: I
authors.initials: I
authors.lastname: Shapira
authors.forename: Y
authors.initials: Y
authors.lastname: Paz
authors.forename: A
authors.initials: A
authors.lastname: Kramer
authors.forename: J
authors.initials: J
authors.lastname: Gurevitch
authors.forename: M
authors.initials: M
authors.lastname: Matsa
authors.forename: D
authors.initials: D
authors.lastname: Pevni
authors.forename: R
authors.initials: R
authors.lastname: Mohr
mesh_terms: D000368:Aged; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis