TIMING OF CORONARY-ARTERY BYPASS-GRAFTING AFTER ACUTE MYOCARDIAL-INFARCTION

Appropriate timing far coronary artery bypass grafting (CABG) after ac ute myocardial infarction (AMI) remains controversial. We retrospectiv ely examined 423 patients who underwent CABG within 21 days of an AMI between 1992 and 1995, mainly for postinfarction angina and complex an atomy. The operative mortality rates associated with increasing time i ntervals between BMI and CABG were 17.4, 9.1, 4.0, and 5.8 per cent, f or less than 6 hours, 6 to 24 hours, 1 to 7 days, and 7 to Za days, re spectively. There were 25 (5.9%) deaths overall. Statistical analysis was performed to evaluate the following preoperative parameters: age, sex, reoperation, previous myocardial infarction (MI), MI type and loc ation, anatomy, cardiogenic shock, unstable angina, ventricular arrhyt hmias, extending MI, ejection fraction, indications for surgery, cardi ac index, and interval from infarction to CABG. Interval between opera tion and AMI did not have a significant impact on patient outcome. Fac tors associated with an increased hospital mortality were ejection fra ction <30 per cent, age >70 years, presence of cardiogenic shock, and cardiac index <1.5. Only cardiac index proved to be a significant pred ictor of mortality (P < 0.001). We conclude that the timing of CABG, i n and of itself, has no significant effect on hospital mortality al sy mptomatic patients within 3 weeks of AMI.