title: Outcome of early revascularization surgery in patients with ST-elevation myocardial infarction.
abstract: OBJECTIVE
  To compare morbidity and mortality of patients with ST-elevation myocardial infarction (MI) undergoing coronary artery bypass graft (CABG) surgery within 24 hours with those who had surgery delayed >24 hours.
  
  
  BACKGROUND
  Patients with ST-elevation MI are currently managed by emergency percutaneous coronary intervention (PCI). If PCI is unsuccessful, or if there is severe coronary artery disease not amenable to PCI, CABG is considered. If the patient is clinically stable, surgeons wait several days before performing surgery, as very early surgery carries a prohibitive risk.
  
  
  METHODS
  One hundred and eighty-four patients with acute ST elevation MI (STEMI) who had undergone CABG were divided into two groups based on their surgery timing (<24 hours vs. >24 hours). Mortality and complication rates were studied between the two groups by Fischer test. Time-to-event analyses were performed for five primary variables: all-cause mortality, cardiac events, congestive heart failure, stroke, and renal failure.
  
  
  RESULTS
  At one month post-CABC, all-cause mortality was noted in 10.6% of patients who had CABG within 24 hours of STEMI diagnosis, compared with 8.9% in patients who had CABG after 24 hours (P = 0.3). Cardiac events including re-exploration, atrial fibrillation, graft occlusion, and arrhythmias requiring shock occurred in 17.1% versus 13.9% between the two groups, respectively (P = 0.68). One year post-coronary artery bypass surgery, there was no difference in individual or combined events between the two groups.
  
  
  CONCLUSIONS
  In patients with ST-elevation myocardial infarction who required emergency coronary artery bypass surgery, there was no difference in procedure complications or mortality between early (within 24 hours) or later (more than 24 hours). That was noted at one month and one year after the index myocardial infarction.
authors: Department of Cardiology, Marshfield Clinic, Marshfield, Wisconsin.
authors: Atif N
authors: AN
authors: Khan
authors: Salah
authors: S
authors: Sabbagh
authors: Sunitha
authors: S
authors: Ittaman
authors: Victor
authors: V
authors: Abrich
authors: Aarti
authors: A
authors: Narayan
authors: Bryan
authors: B
authors: Austin
authors: Shereif H
authors: SH
authors: Rezkalla
mesh_terms: D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology; D001281:Atrial Fibrillation / Q000453:epidemiology; D001026:Coronary Artery Bypass; D005260:Female; D006083:Graft Occlusion, Vascular; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D063868:Patient Outcome Assessment; D012189:Retrospective Studies; D061665:Time-to-Treatment; D014922:Wisconsin / Q000453:epidemiology