The clinical efficacy analysis of early coronary artery bypass grafting to treat ST-segment elevation myocardial infarction / 中华胸心血管外科杂志

ABSTRACT

Objective To evaluate the clinical efficacy of early coronary artery bypass grafting(CABG) to treat ST-segment elevation myocardial infarction(STEMI).Methods We retrospectively analyzed the clinical data of 196 patients within 2 weeks of STEMI attack undergoing CABG in our department from September 2010 to December 2014.According to the time-interval between onset of STEMI and the beginning of CABG,all subjects were divided into group Ⅰ (≤6 h,n =46),group Ⅱ (7-72 h,n =37),group Ⅲ (4-7 d,n =52) and groupⅣV (8-14 d,n =61).After CABG,patients' perioperative complications and survival status were analyzed under different surgical time-interval windows to assess the clinical efficacy of early surgical intervention in patients with STEMI.Results Overall in-hospital mortality was 9.18％ (18/196),from group Ⅰ to group ⅣV,the mortality was 10.87％ (5/46),21.62％ (8/37),5.77％ (3/52) and 3.28％ (2/61) respectively.In all groups,comparing with survivals,nonsurvivals were often women (61.11％ vs.24.16 ％,P =0.002),were more often companied by cardiac shock(83.33％ vs.24.16％,P ＜ 0.001),and had higher preoperative cardiac troponin Ⅰ(cTnⅠ) levels [(14.1 ± 8.4) ng/ml vs.(4.7 ± 3.8) ng/ml,P ＜ 0.001].Multi-variable logistic regrassion analysis revealed that age,female,cardiac shock,renal insufficiency and serum levels of cTnⅠ were independent risk factors affecting postoperative death.Conclusion Under optimal preoperative management strategies,CABG is relatively feasible and effective with the time-interval window as delay as possible after 3 days of STEMI attack.