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The Journal of Cardiovascular Surgery 2021 Nov 18

DOI: 10.23736/S0021-9509.21.11984-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

The timing of surgical revascularisation in acute myocardial infarction: when should we intervene?

Thomas H. YAU 1, Ming H. CHONG 1, Zachary M. BRIGDEN1, Dorette NGEMOH 2, Amer HARKY 3 , Jalal BIN SAEID 3

1 Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK; 2 Medical School, St George’s University of London, London, UK; 3 Department of Cardio-thoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK


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INTRODUCTION: Coronary artery bypass grafting (CABG) is a crucial intervention in acute myocardial infarction (AMI), particularly when AMI is not amenable for management with primary percutaneous coronary intervention (PCI). To optimise outcome in these patients, surgical teams must consider a host of predictive factors, with the most prominent being the timing of CABG. Despite numerous studies exploring timing of CABG following AMI in the past, optimal surgical timing remains controversial. The mortality rates vary with timing of CABG, but confounding factors such as age, impaired pulmonary function, renal insufficiency, and poor left ventricular function may contribute to varied outcomes reported.
EVIDENCE ACQUISITON: An electronic literature search of articles that discussed acute myocardial presentation and urgent in-patient or elective CABG was conducted.
EVIDENCE SYNTHESIS: The evidence was synthesised based on each reported article and their outcomes.
CONCLUSIONS: Current literature suggests multiple factors can guide CABG timing including, type of AMI at initial presentation, distinctive pathological status and patient characteristics. Thus, there is a need for large, multi-centre studies to identify optimal CABG timing in complex coronary artery disease or failed PCI in patients with AMI. Future guidelines should emphasise patient cohorts by taking their risk factors into consideration. As such, a need for greater cardiac screening methods and development of scoring systems can aid in the optimisation of CABG timing.


KEY WORDS: Coronary artery bypass grafting; Outcomes; Timing of CABG; Myocardial infarction; STEMI; NSTEMI

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