Emergency myocardial revascularization for acute myocardial infarction: survival benefits of avoiding cardiopulmonary bypass

Objective: Emergency coronary artery bypass grafting (CABG) for acute myoca rdial infarction (AMI) is associated with increased operative mortality. It has been suggested that this mortality might be reduced by performing the operation without cardiopulmonary bypass (CPB). Methods: Between January 19 92 and April 1998, 77 patients underwent emergency CABG within 48 h of AMI. Thirty seven were operated on with CPB, and 40 without CPB. The two groups were similar regarding age, gender, left-ventricular ejection fraction (EF ) and preoperative use of intra-aortic balloon pump (IABP; 50%). The mean n umber of grafts/patient was 3 in the CPB group, and 1.9 in the No-CPB group (P < 0.0001). Results: Operative mortality in the CPB group was 24% (nine of 37) compared to 5% (two of 40) without CPB (P = 0.015). Follow-up ranged between 6 and 66 months. There were no late deaths in the CPB group compar ed to nine (22%) in the No-CPB group (P < 0.0066). Patients operated on wit h CPB had lower rates of recurrent angina (0 versus 15%; P = 0.0 1) and re- interventions (0 versus 15%; P = 0.04). Conclusions: Our experience suggest s that CABG without CPB is the preferred method of myocardial revasculariza tion, due to the fact that it carries lower mortality than CABG with CPB. T he trade-off includes increased rates of recurrent angina, reinterventions and late mortality. (C) 2000 Elsevier Science B.V. All rights reserved.