title: Surgical Revascularisation in the Early Phase of ST-Segment Elevation Myocardial Infarction: Haemodynamic Status is More Important Than the Timing of the Operation.
abstract: BACKGROUND
  Surgical revascularisation in patients with acute myocardial infarction with ST-Segment Elevation (STEMI) is usually considered as a second choice when direct angioplasty/stent fails. However, improvements in surgical technique and postoperative care may justify coronary artery bypass grafting (CABG) in STEMI.
  
  
  METHODS
  This was a retrospective analysis of prospectively gathered data of 135 patients with acute STEMI, treated with CABG in our department from February 2008 to December 2012. Patients were divided into two groups - operated up to 6 hours (35 patients) and 6 to 24hours (100 patients) from onset of symptoms.
  
  
  RESULTS
  Preoperatively, 18 (13%) patients were in cardiogenic shock, 10 (7.4%) had mechanical ventilation, and 36 (27%) had intra-aortic balloon counterpulsation (IABC). Mean number of distal anastomoses was 3.3 (range, 1 to 5), cardiopulmonary bypass time 122.7+52.6minutes. In hospital (30-day) mortality was 8.1% (11 patients) with no significant difference in both groups (p=0.541); 45 (33%) patients had one MACE, again with no difference in both groups (p=0.89). Risk factor analysis revealed that Killip class at admission, cardiogenic shock, preoperative need for catecholamines, ventilation and low ejection fraction are risk factors for early mortality.
  
  
  CONCLUSIONS
  Acute CABG in patients with STEMI can be performed with good results. Risk factors for early mortality and morbidity are cardiogenic shock, poor haemodynamic status and impaired ejection fraction. Time from infarction to reperfusion did not influence the results.
authors.affiliation: Department of Cardiovascular Surgery, Charles University Hospital Motol, Prague, Czechia. Electronic address: vilem.rohn@seznam.cz.
authors.forename: Vilem
authors.initials: V
authors.lastname: Rohn
authors.affiliation: 2nd Surgical Department Cardiovascular Surgery, Charles University General Teaching Hospital, Prague, Czechia.
authors.forename: Tomas
authors.initials: T
authors.lastname: Grus
authors.affiliation: 2nd Department of Internal Medicine Cardiology and Angiology, Charles University General Teaching Hospital, Prague, Czechia.
authors.forename: Jan
authors.initials: J
authors.lastname: Belohlavek
authors.affiliation: 2nd Department of Internal Medicine Cardiology and Angiology, Charles University General Teaching Hospital, Prague, Czechia.
authors.forename: Jan
authors.initials: J
authors.lastname: Horak
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome
keywords: Acute STEMI; Acute coronary bypass surgery; Surgical treatment of IHD