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Optimal Timing of Coronary Artery Bypass Grafting in Haemodynamically Stable Patients after Myocardial Infarction
During the acute phase of myocardial infarction, the culprit artery must be revascularized quickly with angioplasty. Surgery then completes the procedure in a second stage. If emergency surgery is performed, the resulting death rate is high; 15–20% of patients are operated on within the first 48 h a...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10046680/ https://www.ncbi.nlm.nih.gov/pubmed/36979958 http://dx.doi.org/10.3390/biomedicines11030979 |
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author | Bernard, Chloé Morgant, Marie Catherine Jazayeri, Aline Perrin, Thomas Malapert, Ghislain Jazayeri, Saed Bernard, Alain Bouchot, Olivier |
author_facet | Bernard, Chloé Morgant, Marie Catherine Jazayeri, Aline Perrin, Thomas Malapert, Ghislain Jazayeri, Saed Bernard, Alain Bouchot, Olivier |
author_sort | Bernard, Chloé |
collection | PubMed |
description | During the acute phase of myocardial infarction, the culprit artery must be revascularized quickly with angioplasty. Surgery then completes the procedure in a second stage. If emergency surgery is performed, the resulting death rate is high; 15–20% of patients are operated on within the first 48 h after the myocardial infarction. The timing of surgical revascularization and the patient’s preoperative state influence the mortality rate. We aimed to evaluate the impact of surgery delay on morbimortality. Between 2007 and 2017, a retrospective monocentric study was conducted including 477 haemodynamically stable patients after myocardial infarction who underwent an urgent coronary bypass. Three groups were described, depending on the timing of the surgery: during the first 4 days (Group 1, n = 111, 23%), 5 to 10 days (Group 2, n = 242, 51%) and after 11 days (Group 3, n = 124, 26%). The overall thirty-day mortality was 7.1% (n = 34). The death rate was significantly higher in Group 1 (n = 16; 14% vs. n = 10; 4.0% vs. n = 8; 6%, p < 0.01). The mortality risk factors identified were age (OR: 1.08; CI 95%: 1.04–1.12; p < 0.001), peripheral arteriopathy (OR: 3.31; CI 95%: 1.16–9.43; p = 0.024), preoperative renal failure (OR: 6.39; CI 95%: 2.49–15.6; p < 0.001) and preoperative ischemic recurrence (OR: 3.47; CI 95%: 1.59–7.48; p < 0.01). Ninety-two patients presented with preoperative ischemic recurrence (19%), with no difference between the groups. The optimal timing for the surgical revascularization of MI seems to be after Day 4 in stable patients. However, timing is not the only factor influencing the death rate: the patient’s health condition and disease severity must be considered in the individual management strategy. |
format | Online Article Text |
id | pubmed-10046680 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-100466802023-03-29 Optimal Timing of Coronary Artery Bypass Grafting in Haemodynamically Stable Patients after Myocardial Infarction Bernard, Chloé Morgant, Marie Catherine Jazayeri, Aline Perrin, Thomas Malapert, Ghislain Jazayeri, Saed Bernard, Alain Bouchot, Olivier Biomedicines Article During the acute phase of myocardial infarction, the culprit artery must be revascularized quickly with angioplasty. Surgery then completes the procedure in a second stage. If emergency surgery is performed, the resulting death rate is high; 15–20% of patients are operated on within the first 48 h after the myocardial infarction. The timing of surgical revascularization and the patient’s preoperative state influence the mortality rate. We aimed to evaluate the impact of surgery delay on morbimortality. Between 2007 and 2017, a retrospective monocentric study was conducted including 477 haemodynamically stable patients after myocardial infarction who underwent an urgent coronary bypass. Three groups were described, depending on the timing of the surgery: during the first 4 days (Group 1, n = 111, 23%), 5 to 10 days (Group 2, n = 242, 51%) and after 11 days (Group 3, n = 124, 26%). The overall thirty-day mortality was 7.1% (n = 34). The death rate was significantly higher in Group 1 (n = 16; 14% vs. n = 10; 4.0% vs. n = 8; 6%, p < 0.01). The mortality risk factors identified were age (OR: 1.08; CI 95%: 1.04–1.12; p < 0.001), peripheral arteriopathy (OR: 3.31; CI 95%: 1.16–9.43; p = 0.024), preoperative renal failure (OR: 6.39; CI 95%: 2.49–15.6; p < 0.001) and preoperative ischemic recurrence (OR: 3.47; CI 95%: 1.59–7.48; p < 0.01). Ninety-two patients presented with preoperative ischemic recurrence (19%), with no difference between the groups. The optimal timing for the surgical revascularization of MI seems to be after Day 4 in stable patients. However, timing is not the only factor influencing the death rate: the patient’s health condition and disease severity must be considered in the individual management strategy. MDPI 2023-03-22 /pmc/articles/PMC10046680/ /pubmed/36979958 http://dx.doi.org/10.3390/biomedicines11030979 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Bernard, Chloé Morgant, Marie Catherine Jazayeri, Aline Perrin, Thomas Malapert, Ghislain Jazayeri, Saed Bernard, Alain Bouchot, Olivier Optimal Timing of Coronary Artery Bypass Grafting in Haemodynamically Stable Patients after Myocardial Infarction |
title | Optimal Timing of Coronary Artery Bypass Grafting in Haemodynamically Stable Patients after Myocardial Infarction |
title_full | Optimal Timing of Coronary Artery Bypass Grafting in Haemodynamically Stable Patients after Myocardial Infarction |
title_fullStr | Optimal Timing of Coronary Artery Bypass Grafting in Haemodynamically Stable Patients after Myocardial Infarction |
title_full_unstemmed | Optimal Timing of Coronary Artery Bypass Grafting in Haemodynamically Stable Patients after Myocardial Infarction |
title_short | Optimal Timing of Coronary Artery Bypass Grafting in Haemodynamically Stable Patients after Myocardial Infarction |
title_sort | optimal timing of coronary artery bypass grafting in haemodynamically stable patients after myocardial infarction |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10046680/ https://www.ncbi.nlm.nih.gov/pubmed/36979958 http://dx.doi.org/10.3390/biomedicines11030979 |
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