The Egyptian Cardiothoracic Surgeon

Background: The optimal timing for coronary artery bypass grafting (CABG) surgery after myocardial infarction remains a matter of debate. Our study aimed to analyze the effect of the timing of CABG surgery after acute myocardial infarction on operative mortality and morbidity. Methods: This prospective study included 60 patients who underwent isolated CABG within 30 days of acute myocardial infarction from November 2014 to June 2016 in Kasr Al-Ainy University Hospitals. Patients were divided into two groups according to the timing of surgery; the early group (0 – 3 days) included 14 patients (23.3%), and the late group (4 – 30 days) included 46 patients (76.7%). The outcomes of the study were all-cause hospital mortality and morbidity. Results: Our study included 43 males (71.7%), and the mean age was 58.4 ± 7.3 years. Five patients had preoperative arrhythmia (36%) in the early group vs. two patients in the late group (4%) (p=0.006). The use of an intra-aortic balloon pump (IABP) preoperatively was required in four patients (6.7%); all were in the early group (p= 0.002). Preoperative high inotropic support was required in 11 (78.6%) in the early group vs. 5 (10.9%) in the late group (p< 0.001). Postoperative IABP was required in 6 (42.9%) patients in the early group vs. 4 (8.7%) patients in the late group (p= 0.007). The duration of mechanical ventilation was 19.9±18.9 hours in the early group vs. 9±13.6 hours in the late group (p= 0.001). The duration of ICU stay was 102.5±77.8 and 55.8±22 hours in the early and late groups, respectively (p= 0.001). The total mortality rate was 5 (8.3%) patients; 3 (21.4%) in the early group vs. 2 (4.3%) in the late group (p = 0.078). Conclusion: We reported higher mortality and morbidity if CABG is performed in the first three days after acute myocardial infarction. The course of patients who had late CABG was better than who had early CABG.

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