title: Predictors and outcomes of coronary artery bypass grafting in ST elevation myocardial infarction.
abstract: BACKGROUND
  Treatment of ST-elevation myocardial infarction has undergone great evolution since introduction of percutaneous coronary intervention (PCI). The purpose was therefore to assess the outcome of patients with ST-elevation myocardial infarction undergoing surgical revascularization with coronary artery bypass grafting (CABG).
  
  
  METHODS
  A total of 138 consecutive patients with ST-elevation myocardial infarction underwent CABG therapy between January 2000 and January 2007 at our institution. Prospectively recorded preoperative, intraoperative, and postoperative data were retrospectively screened for in-hospital mortality and major adverse cardiac events (MACE).
  
  
  RESULTS
  The delay between the onset of ST-elevation myocardial infarction symptoms and CABG procedures was within 6 hours in 37 patients, 7 to 24 hours in 21, 1 to 3 days in 15, 4 to 7 days in 24, and 8 to 14 days in 41 patients. Cardiogenic shock (Killip class > or = III) was present in 38 patients (28%), and 37 patients (27%) were referred for CABG after failed PCI. Overall in-hospital mortality was 8.7%, but mortality varied between 10.8% (< or = 6 hours), 23.8% (7 to 24 hours), 6.7% (1 to 3 days), 4.2% (4 to 7 days), and 2.4% (8 to 14 days), depending on time interval from symptom onset to operation. Overall, more nonsurvivors were women (58% versus 23%; p < 0.01), had higher preoperative cardiac troponin I levels (13.2 +/- 9.8 versus 4.5 +/- 4.2 ng/ml; p < 0.0001), and were more frequently in cardiogenic shock (83% versus 22%; p < 0.0001). Unadjusted univariable and risk-adjusted multivariable logistic regression analysis revealed age, female sex, preoperative cardiac troponin I levels, and cardiogenic shock to be the most potent predictors of in-hospital death and MACE.
  
  
  CONCLUSIONS
  CABG in ST-elevation myocardial infarction can be performed with acceptable risk by incorporating adequate management strategies. However, female sex, preoperative cardiac troponin I level, preoperative cardiogenic shock, and time to operation are major variables of mortality and morbidity results.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, Essen, Germany. matthias.thielmann@uni-due.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Thielmann
authors.forename: Markus
authors.initials: M
authors.lastname: Neuhäuser
authors.forename: Anja
authors.initials: A
authors.lastname: Marr
authors.forename: Ulf
authors.initials: U
authors.lastname: Herold
authors.forename: Markus
authors.initials: M
authors.lastname: Kamler
authors.forename: Parwis
authors.initials: P
authors.lastname: Massoudy
authors.forename: Heinz
authors.initials: H
authors.lastname: Jakob
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D019210:Troponin I