Is delayed surgical revascularization in acute myocardial infarction useful or dangerous? New insights into an old problem
Abstract OBJECTIVES Haemodynamically stable patients admitted for coronary artery bypass grafting in acute myocardial infarction often undergo delayed surgery in order to avoid the risks of emergency surgery. However, initially stable patients undergoing delayed surgery may develop low cardiac outpu...
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| Veröffentlicht in: | Interactive cardiovascular and thoracic surgery 2017-11, Vol.25 (5), p.772-779 |
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| creator | Grieshaber, Philippe Roth, Peter Oster, Lukas Schneider, Tobias M. Görlach, Gerold Nieman, Bernd Böning, Andreas |
| description | Abstract
OBJECTIVES
Haemodynamically stable patients admitted for coronary artery bypass grafting in acute myocardial infarction often undergo delayed surgery in order to avoid the risks of emergency surgery. However, initially stable patients undergoing delayed surgery may develop low cardiac output syndrome (LCOS) during the waiting period, which might be a major drawback of this strategy. We aim to define risk factors and clinical consequences of LCOS during the waiting period.
METHODS
A total of 530 consecutive patients with acute myocardial infarction (33% non-ST-segment elevation myocardial infarction and 67% ST-segment-elevation myocardial infarction) underwent isolated coronary artery bypass grafting between 2008 and 2013. Outcomes after either immediate (48 h after onset of symptoms) therapy were compared. Predictors of preoperative development of LCOS were identified using multivariate regression analysis.
RESULTS
Of the 327 patients undergoing delayed therapy, 39 (12%) developed preoperative LCOS, resulting in increased mortality compared with patients who remained stable (21 vs 7.6%, P |
| doi_str_mv | 10.1093/icvts/ivx188 |
| format | Article |
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OBJECTIVES
Haemodynamically stable patients admitted for coronary artery bypass grafting in acute myocardial infarction often undergo delayed surgery in order to avoid the risks of emergency surgery. However, initially stable patients undergoing delayed surgery may develop low cardiac output syndrome (LCOS) during the waiting period, which might be a major drawback of this strategy. We aim to define risk factors and clinical consequences of LCOS during the waiting period.
METHODS
A total of 530 consecutive patients with acute myocardial infarction (33% non-ST-segment elevation myocardial infarction and 67% ST-segment-elevation myocardial infarction) underwent isolated coronary artery bypass grafting between 2008 and 2013. Outcomes after either immediate (<48 h after onset of symptoms) or delayed (>48 h after onset of symptoms) therapy were compared. Predictors of preoperative development of LCOS were identified using multivariate regression analysis.
RESULTS
Of the 327 patients undergoing delayed therapy, 39 (12%) developed preoperative LCOS, resulting in increased mortality compared with patients who remained stable (21 vs 7.6%, P < 0.001). Immediate therapy resulted in similar mortality compared with delayed therapy (6.4 vs 7.6%; P = 0.68) and better 7-year survival (70 vs 55%; P < 0.001). Predictors of developing LCOS were reduced left ventricular function (odds ratio 4.4), renal impairment (odds ratio 3.0), acute pulmonary infection (odds ratio 3.4) and the extent of troponin elevation at admission (odds ratio 1.01 per increase by 1 µg/l).
CONCLUSIONS
In patients with acute myocardial infarction undergoing delayed coronary artery bypass grafting, preoperative LCOS is a relevant and dangerous condition that can be avoided by operating immediately or by carefully selecting patients to be delayed according to the risk parameters identified preoperatively.</description><identifier>ISSN: 1569-9293</identifier><identifier>EISSN: 1569-9285</identifier><identifier>DOI: 10.1093/icvts/ivx188</identifier><identifier>PMID: 28637179</identifier><language>eng</language><publisher>England: Oxford University Press</publisher><subject>Aged ; Cause of Death - trends ; Coronary Angiography ; Electrocardiography ; Female ; Follow-Up Studies ; Germany - epidemiology ; Humans ; Male ; Middle Aged ; Myocardial Infarction - diagnosis ; Myocardial Infarction - mortality ; Myocardial Infarction - surgery ; Myocardial Revascularization - methods ; Odds Ratio ; Retrospective Studies ; Risk Factors ; Survival Rate - trends ; Time Factors</subject><ispartof>Interactive cardiovascular and thoracic surgery, 2017-11, Vol.25 (5), p.772-779</ispartof><rights>The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2017</rights><rights>The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c361t-b593980cb658bf13fce10656c93702ec1d046f718b801a4c874219e373b2315b3</citedby><cites>FETCH-LOGICAL-c361t-b593980cb658bf13fce10656c93702ec1d046f718b801a4c874219e373b2315b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1598,27901,27902</link.rule.ids><linktorsrc>$$Uhttps://dx.doi.org/10.1093/icvts/ivx188$$EView_record_in_Oxford_University_Press$$FView_record_in_$$GOxford_University_Press</linktorsrc><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28637179$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Grieshaber, Philippe</creatorcontrib><creatorcontrib>Roth, Peter</creatorcontrib><creatorcontrib>Oster, Lukas</creatorcontrib><creatorcontrib>Schneider, Tobias M.</creatorcontrib><creatorcontrib>Görlach, Gerold</creatorcontrib><creatorcontrib>Nieman, Bernd</creatorcontrib><creatorcontrib>Böning, Andreas</creatorcontrib><title>Is delayed surgical revascularization in acute myocardial infarction useful or dangerous? New insights into an old problem</title><title>Interactive cardiovascular and thoracic surgery</title><addtitle>Interact Cardiovasc Thorac Surg</addtitle><description>Abstract
OBJECTIVES
Haemodynamically stable patients admitted for coronary artery bypass grafting in acute myocardial infarction often undergo delayed surgery in order to avoid the risks of emergency surgery. However, initially stable patients undergoing delayed surgery may develop low cardiac output syndrome (LCOS) during the waiting period, which might be a major drawback of this strategy. We aim to define risk factors and clinical consequences of LCOS during the waiting period.
METHODS
A total of 530 consecutive patients with acute myocardial infarction (33% non-ST-segment elevation myocardial infarction and 67% ST-segment-elevation myocardial infarction) underwent isolated coronary artery bypass grafting between 2008 and 2013. Outcomes after either immediate (<48 h after onset of symptoms) or delayed (>48 h after onset of symptoms) therapy were compared. Predictors of preoperative development of LCOS were identified using multivariate regression analysis.
RESULTS
Of the 327 patients undergoing delayed therapy, 39 (12%) developed preoperative LCOS, resulting in increased mortality compared with patients who remained stable (21 vs 7.6%, P < 0.001). Immediate therapy resulted in similar mortality compared with delayed therapy (6.4 vs 7.6%; P = 0.68) and better 7-year survival (70 vs 55%; P < 0.001). Predictors of developing LCOS were reduced left ventricular function (odds ratio 4.4), renal impairment (odds ratio 3.0), acute pulmonary infection (odds ratio 3.4) and the extent of troponin elevation at admission (odds ratio 1.01 per increase by 1 µg/l).
CONCLUSIONS
In patients with acute myocardial infarction undergoing delayed coronary artery bypass grafting, preoperative LCOS is a relevant and dangerous condition that can be avoided by operating immediately or by carefully selecting patients to be delayed according to the risk parameters identified preoperatively.</description><subject>Aged</subject><subject>Cause of Death - trends</subject><subject>Coronary Angiography</subject><subject>Electrocardiography</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Germany - epidemiology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - diagnosis</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - surgery</subject><subject>Myocardial Revascularization - methods</subject><subject>Odds Ratio</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Survival Rate - trends</subject><subject>Time Factors</subject><issn>1569-9293</issn><issn>1569-9285</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kD1PwzAQhi0EoqWwMSNvMFDwxU1iTwhVfEkVLDBHjnMpRk5c7LhQfj2hhY5M90r36L3TQ8gxsAtgkl8avezCpVl-ghA7ZAhpJscyEenuNks-IAchvDEGknG2TwaJyHgOuRySr4dAK7RqhRUN0c-NVpZ6XKqgo1XefKnOuJaaliodO6TNymnlK9NTpq2V1-t1DFhHS52nlWrn6F0MV_QRP3ommPlrF_rQOapa6mxFF96VFptDslcrG_Dod47Iy-3N8_R-PHu6e5hez8aaZ9CNy1RyKZgus1SUNfBaI7AszbTkOUtQQ8UmWZ2DKAUDNdEinyQgkee8TDikJR-Rs01vf_c9YuiKxgSN1qoW-0cLkJBkLBdp2qPnG1R7F4LHulh40yi_KoAVP7aLte1iY7vHT36bY9lgtYX_9PbA6QZwcfF_1TcrhYxG</recordid><startdate>20171101</startdate><enddate>20171101</enddate><creator>Grieshaber, Philippe</creator><creator>Roth, Peter</creator><creator>Oster, Lukas</creator><creator>Schneider, Tobias M.</creator><creator>Görlach, Gerold</creator><creator>Nieman, Bernd</creator><creator>Böning, Andreas</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20171101</creationdate><title>Is delayed surgical revascularization in acute myocardial infarction useful or dangerous? New insights into an old problem</title><author>Grieshaber, Philippe ; Roth, Peter ; Oster, Lukas ; Schneider, Tobias M. ; Görlach, Gerold ; Nieman, Bernd ; Böning, Andreas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c361t-b593980cb658bf13fce10656c93702ec1d046f718b801a4c874219e373b2315b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Cause of Death - trends</topic><topic>Coronary Angiography</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Germany - epidemiology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - diagnosis</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - surgery</topic><topic>Myocardial Revascularization - methods</topic><topic>Odds Ratio</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Survival Rate - trends</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Grieshaber, Philippe</creatorcontrib><creatorcontrib>Roth, Peter</creatorcontrib><creatorcontrib>Oster, Lukas</creatorcontrib><creatorcontrib>Schneider, Tobias M.</creatorcontrib><creatorcontrib>Görlach, Gerold</creatorcontrib><creatorcontrib>Nieman, Bernd</creatorcontrib><creatorcontrib>Böning, Andreas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Interactive cardiovascular and thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext_linktorsrc</fulltext></delivery><addata><au>Grieshaber, Philippe</au><au>Roth, Peter</au><au>Oster, Lukas</au><au>Schneider, Tobias M.</au><au>Görlach, Gerold</au><au>Nieman, Bernd</au><au>Böning, Andreas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is delayed surgical revascularization in acute myocardial infarction useful or dangerous? New insights into an old problem</atitle><jtitle>Interactive cardiovascular and thoracic surgery</jtitle><addtitle>Interact Cardiovasc Thorac Surg</addtitle><date>2017-11-01</date><risdate>2017</risdate><volume>25</volume><issue>5</issue><spage>772</spage><epage>779</epage><pages>772-779</pages><issn>1569-9293</issn><eissn>1569-9285</eissn><abstract>Abstract
OBJECTIVES
Haemodynamically stable patients admitted for coronary artery bypass grafting in acute myocardial infarction often undergo delayed surgery in order to avoid the risks of emergency surgery. However, initially stable patients undergoing delayed surgery may develop low cardiac output syndrome (LCOS) during the waiting period, which might be a major drawback of this strategy. We aim to define risk factors and clinical consequences of LCOS during the waiting period.
METHODS
A total of 530 consecutive patients with acute myocardial infarction (33% non-ST-segment elevation myocardial infarction and 67% ST-segment-elevation myocardial infarction) underwent isolated coronary artery bypass grafting between 2008 and 2013. Outcomes after either immediate (<48 h after onset of symptoms) or delayed (>48 h after onset of symptoms) therapy were compared. Predictors of preoperative development of LCOS were identified using multivariate regression analysis.
RESULTS
Of the 327 patients undergoing delayed therapy, 39 (12%) developed preoperative LCOS, resulting in increased mortality compared with patients who remained stable (21 vs 7.6%, P < 0.001). Immediate therapy resulted in similar mortality compared with delayed therapy (6.4 vs 7.6%; P = 0.68) and better 7-year survival (70 vs 55%; P < 0.001). Predictors of developing LCOS were reduced left ventricular function (odds ratio 4.4), renal impairment (odds ratio 3.0), acute pulmonary infection (odds ratio 3.4) and the extent of troponin elevation at admission (odds ratio 1.01 per increase by 1 µg/l).
CONCLUSIONS
In patients with acute myocardial infarction undergoing delayed coronary artery bypass grafting, preoperative LCOS is a relevant and dangerous condition that can be avoided by operating immediately or by carefully selecting patients to be delayed according to the risk parameters identified preoperatively.</abstract><cop>England</cop><pub>Oxford University Press</pub><pmid>28637179</pmid><doi>10.1093/icvts/ivx188</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Cause of Death - trends Coronary Angiography Electrocardiography Female Follow-Up Studies Germany - epidemiology Humans Male Middle Aged Myocardial Infarction - diagnosis Myocardial Infarction - mortality Myocardial Infarction - surgery Myocardial Revascularization - methods Odds Ratio Retrospective Studies Risk Factors Survival Rate - trends Time Factors |
| title | Is delayed surgical revascularization in acute myocardial infarction useful or dangerous? New insights into an old problem |
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