Coronary artery bypass grafting within 30 days after treatment of acute myocardial infarctions with angioplasty or fibrinolysis - a surgical substudy of DANAMI-2.
OBJECTIVE
To calculate the incidence and analyse the indications and outcome after surgical revascularization within the first 30 days after randomization of 1572 patients with acute myocardial infarction (MI) associated with ST-segment elevation (STEMI).


METHODS
Data regarding the patients undergoing heart surgery within the first 30 days after randomization were collected.


RESULTS
Three patients (0.2%) with acute STEMI and randomized to percutaneous coronary intervention (PCI) underwent emergent coronary artery bypass grafting (CABG). A total of 50 patients (3.2%), 30 in the PCI group and 20 in the fibrinolysis group were revascularized by surgery within the first 30 days after randomization. The most frequent indication for surgery in both groups was unstable angina pectoris, followed by left main stenosis. The incidence of postoperative complications was higher compared with the outcome after elective CABG.


CONCLUSIONS
The incidence of emergency CABG in this study was low (0.2%) after treatment of acute MI with either PCI or fibrinolysis. The overall incidence within 30 days was 3.2%, however, the mortality is increased with a 30-day mortality of 10% in this high-risk patient group.
Kjaergard
Henrik
H
Department of Cardiothoracic Surgery, Gentofte Hospital, Hellerup, Denmark. hekja@gentoftehosp.kbhamt.dk
Nielsen
Per Hostrup
PH
Andreasen
Jan Jesper
JJ
Steinbrüchel
Daniel
D
Andersen
Lars Ib
LI
Rasmussen
Klaus
K
Andersen
Henning Rud
HR
Nielsen
Torsten Toftegaard
TT
D000208:Acute Disease; D000368:Aged; D000800:Angioplasty, Balloon; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data*; D004562:Electrocardiography; D005260:Female; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D009204:Myocardial Revascularization / Q000401:mortality / Q000706:statistics & numerical data*; D018579:Patient Selection; D016896:Treatment Outcome