title: Results of emergency coronary artery bypass grafting for acute myocardial infarction: importance of intraoperative and postoperative cardiac medical therapy.
abstract: BACKGROUND
  The results of emergency coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) are less than satisfactory, and readmission for cardiac events is common.
  
  
  RESULTS
  105 patients underwent emergency CABG for AMI. We examined the long-term results of emergency CABG for AMI from the viewpoints of preoperative, intraoperative, and postoperative factors. The operative mortality rate was 11.4%. Risk factors for early death were age ≥80 years, shock, veno-arterial bypass, creatine kinase isoenzyme Mb ≥100 U/L, non-use of a left internal thoracic artery graft and an extracorporeal circulation time ≥120 min. Risk factors for late cardiac events were ejection fraction <40%, non-use of human atrial natriuretic peptide (hANP) therapy, angiotensin II receptor blockers (ARB) and aldosterone blockers, and a 3-month postoperative brain natriuretic peptide level ≥200 pg/ml.
  
  
  CONCLUSIONS
  Early results of this study are similar to those seen in previous reports, whereas late phase results yield some new and interesting findings. We suggest that intraoperative hANP, and postoperative aldosterone blocker and ARB, following CABG for AMI, will, through control of the renin-angiotensin-aldsterone system, inhibit left ventricular remodelling, reduce the extent of infarction, and improve cardiac function, yielding a favourable long-term prognosis.
authors.affiliation: The Department of Cardiovascular Surgery, Department of Cardiology, Nihon University School of Medicine, Tokyo, Japan. asezai.med@gmail.com
authors.forename: Akira
authors.initials: A
authors.lastname: Sezai
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Hata
authors.forename: Isamu
authors.initials: I
authors.lastname: Yoshitake
authors.forename: Haruka
authors.initials: H
authors.lastname: Kimura
authors.forename: Kana
authors.initials: K
authors.lastname: Takahashi
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hata
authors.forename: Motomi
authors.initials: M
authors.lastname: Shiono
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002317:Cardiovascular Agents / Q000627:therapeutic use; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D052279:Creatine Kinase, MB Form / Q000097:blood; D018572:Disease-Free Survival; D004630:Emergencies; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007430:Intraoperative Care; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011182:Postoperative Care; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
chemical_list: D015415:Biomarkers; D002317:Cardiovascular Agents; D020097:Natriuretic Peptide, Brain; D052279:Creatine Kinase, MB Form