Surgical management of unstable patients in the evolving phase of acute myocardial infarction

Background. Acute myocardial infarction (AMI) can be treated with thromboly sis or coronary catheter intervention; surgical treatment-coronary artery b ypass grafting (CABG)-is reserved for the patients in whom other procedures have failed. We performed CABG in 47 patients during the evolving phase of AMI, and analyzed their short-term and long-term results. Methods. Preoperative, intraoperative, and postoperative data were analyzed in patients who underwent emergency CABGs for AMI between January 1, 1992, and July 31, 1998. CABGs performed more than 7 days after AMI were exclude d from this study. Results. The subjects were 47 patients (33 males and 14 females) with AMI W ho were treated by emergency CABG. Intraaortic balloon pumping was used in 44 cases and percutaneous circulatory pulmonary support was used in 3 cases . The mean interval between the onset of AMI and surgery was 27.4 +/- 27.9 hours. The mean number of bypass grafts was 3.0 +/- 1.1, and at least 1 art erial conduit was used in 45 cases (95.7%). Aortic clamp time, pump time, a nd operative time were 64.7 +/- 31.7, 117.3 +/- 55.2, and 313.2 +/- 84.8 mi nutes, respectively. IABP or percutaneous cardiopulmonary support were remo ved in the intensive care unit (ICU) 30.0 +/- 28.9 hours after CABG. The pa tients were extubated 41.4 +/- 40.5 hours after surgery, remained in ICU fo r 4.7 +/- 2.7 days, and were discharged from the hospital after 27.0 +/- 22 .5 days. Three patients died from multiorgan failure related to postoperati ve sepsis, and 8 cases of major complications were observed. The actuarial 5-year survival rate of the patients treated with CABG was 83.0%. Conclusions. Surgical treatment in the unstable patients after AMI can be p erformed with acceptable risk. Arterial revascularization may contribute to improvement in long-term results.