Coronary artery bypass surgery within 48 hours after cardiac arrest due to acute myocardial infarction

Abstract

OBJECTIVES: Cardiac arrest (CA) in patients with acute myocardial infarction is associated with a poor prognosis. Due to the additional trauma, risk of stroke and lack of data, coronary artery bypass grafting (CABG) is a controversial revascularization strategy for patients who cannot be treated percutaneously. Against this background, we investigated the outcome of patients from our department with acute myocardial infarction undergoing CABG after CA.METHODS: Between January 2001 and January 2015, 129 patients with preoperative CA due to acute myocardial infarction underwent CABG at our institution within 48 h after the CA had occurred. Predictors of in-hospital and long-term mortality were analysed. Neurological outcome according to cerebral performance category scale was investigated.RESULTS: Sixty CA (47%) events occurred out-of-hospital. Ventricular fibrillation was the major underlying arrhythmia (n = 92, 71%). The mean age was 65 ± 10 years. Eighty-four patients (65%) were diagnosed with ST-elevation myocardial infarction and 108 patients (84%) had 3-vessel coronary artery disease. Forty-three cases (33%) underwent percutaneous transluminal angioplasty. The median time to CABG was 4 (range 0.2–4) h. Complete revascularization was achieved in 106 patients (83%). The stroke rate was 9% (n = 11) and hypoxic brain damage occurred in 16 patients (12%). Nine subjects (7%) needed extracorporeal life support. Four intraoperative deaths (3%) occurred; the 30-day mortality rate was 23% (n = 30); the mortality rate during follow-up was 30% (n = 27). A total of 79% (n = 70) of patients discharged alive showed good neurological outcome according to the cerebral performance category scale.CONCLUSIONS: Despite the reluctance to expose patients with CA to early CABG, our data indicate that the operative strategy may not be as unfavourable as suspected.

http://ift.tt/2ubn0AV