The role of elective coronary surgery early after acute myocardial infarction in the era of primary percutaneous coronary intervention

Abstract

Aims — There is a group of patients with acute myocardial infarction (AMI), who, according to results of emergency coronary angiography and regardless of performed or not performed primary percutaneous coronary intervention (PCI), are qualified for elective coronary artery bypass grafting (CABG).The authors have not found a publication that focuses on this problem.They tried to determine the base-line characteristic of this subgroup as well as appreciate its operative surgical risk.

Methods and results — Emergency coronary angiography - followed by primary PCI when appropriate - was performed in 1867 consecutive patients with AMI. Of all these patients, 85 (4.6%) were qualified at the further stage of treatment for elective CABG. Compared with patients requiring only PCI (n=1771), those undergoing elective CABG were the same age (61.9±9.4 vs. 61.8±12.8years) and gender, but more frequently suffered from hypertension, diabetes mellitus, lipid disorders and multi-vessel disease. The majority of CABG patients (56.5%) belonged to the medium risk group according to the calculated EuroSCORE ratio.The mean value of the logistic EuroSCORE was 5.26 ±8.07.

Conclusions — The elective CABG in patients early after AMI, who underwent emergency coronary angiography to perform primary PCI, is an integral part of treatment. However, this procedure usually regards only few patients. Numerous risk factors of coronary artery disease are present in those patients, who belong, however, to the medium operative risk group.

Key Words:

• elective CABG
• primary PCI
• AMI