title: Appropriate timing of coronary artery bypass grafting after acute myocardial infarction.
abstract: OBJECTIVE
  Optimal timing of coronary artery bypass grafting (CABG) after acute myocardial infarction (AMI) remains the subject of fierce debate. Therefore, the recommended deferral ranges from immediate intervention to surgery 4 weeks after infarction. Especially, the increasing cohorts of patients at old age or with poor left ventricular function, whose mortality rates are additionally enhanced, may profit from focused analyses. This study aims at clarifying the appropriate timing of CABG after AMI, with special regard to high-risk patients (Age >70 years, left ventricular ejection fraction (LVEF) <30%).
  
  
  METHODS
  Retrospective analysis was performed in 3475 patients who had undergone isolated CABG between 2005 and 2009. Those 1168 patients with previous AMI (<30 days) were categorized in groups, depending on deferral of surgery: <6 hours after AMI (A), 6 hours-1 day (B), 2-3 days (C), 4-10 days (D), 11-20 days (E), and 21-30 days (F). Furthermore, subgroups with an age >70 years or a LVEF <30% were examined.
  
  
  RESULTS
  The mortality rates in groups A-F were 14.8, 10.2, 8.8, 4.2, 2.3, and 2.0%, whereas only the values of groups A-D were significantly increased versus the mortality rate of patients without previous AMI (1.9%). In patients over 70 years, we observed operative mortalities of 26.3, 14.3, 11.9, 6.1, 4.2, and 3.1% (groups A-F) versus 2.5% (no previous AMI), while 27.4, 15.4, 11.7, 6.0, 3.7, and 2.8% (groups A-F) versus 2.7% (no previous AMI) of patients with a LVEF <30% died during the first 30 days after surgery. In both subanalyses of high-risk patients, the enhanced mortalities of groups A-E reached significance. Multivariate analysis of operative risk factors revealed that CABG within 10 days after AMI and age over 60 years are independently associated with operative mortality.
  
  
  CONCLUSIONS
  CABG early after AMI (<10 days) is accompanied by significantly increased mortality, especially in elderly patients or in patients with a severely impaired LVEF. At least the critical time period of 3 days should be avoided-whenever the hemodynamics is stable enough.
authors.affiliation: Department of Cardiovascular Surgery, Medical Faculty, University Duesseldorf, Duesseldorf, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Assmann
authors.forename: Udo
authors.initials: U
authors.lastname: Boeken
authors.forename: Payam
authors.initials: P
authors.lastname: Akhyari
authors.forename: Artur
authors.initials: A
authors.lastname: Lichtenberg
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003324:Coronary Artery Disease / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D016017:Odds Ratio; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left