Immediate surgical coronary revascularisation in patients presenting with acute myocardial infarction

Background: The number of patients presenting with acute myocardial
infarction (AMI) and being untreatable by interventional
cardiologists increased during the last years. Previous experience
in emergency coronary artery bypass grafting (CABG) in these
patients spurred us towards a more liberal acceptance for surgery.
Following a prospective protocol, patients were operated on and
further analysed. Methods: Within a two year interval, 127 patients
(38 female, age 68 +/- 12 years, EuroScore (ES) II 6.7 +/- 7.2\%)
presenting with AMI (86 non-ST-elevated myocardial infarction
(NSTEMI), 41 STEMI) were immediately accepted for emergency CABG
and operated on within six hours after cardiac catheterisation
(77\% three-vessel-disease, 47\% left main stem stenosis, 11\%
cardiogenic shock, 21\% preoperative intraaortic balloon pump
(IABP), left ventricular ejection fraction 48 +/- 15\%). Results:
30-day-mortality was 6\% (8 patients, 2 NSTEMI (2\%) 6 STEMI
(15\%), p=0.014). Complete revascularisation could be achieved in
80\% of the patients using 2 +/- 1 grafts and 3 +/- 1 distal
anastomoses. In total, 66\% were supported by IABP, extracorporal
life support (ECLS) systems were implanted in two patients.
Logistic regression analysis revealed the ES II as an independent
risk factor for mortality (p