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Off-pump Coronary Artery Bypass Grafting for Acute Myocardial Infarction
Tomoya Uchimuro, Toshihiro Fukui, Yasuyuki Katou, Minoru Tabata, Shuichiro Takanashi.
Sakakibara Heart Institute, Tokyo, Japan.

OBJECTIVE: High mortality has been reported in conventional coronary artery bypass grafting (CABG) for patients with acute myocardial infarction (AMI). Recently, off-pump CABG is widely accepted to be safe and effective for myocardial revascularization. We assessed the outcome of off-pump CABG for patients with AMI.
METHODS: Between September 2004 and April 2012, 1506 patients underwent off-pump CABG; of these patients, 97 consecutive patients (6.4%) with AMI were assessed. Postoperative coronary angiography was performed in 66 patients (68.0%) at 1 week after surgery. Forty-nine patients (50.5%) had coronary angiography at 1 year after surgery. The mean follow-up time was 4.0±2.3 years. Long-term survival was analyzed using Kaplan-Meier survival curves. Cox proportional hazard analysis was performed to identify independent predictors of mortality.
RESULTS: Mean age at operation was 70.8 years, and 76 (78.4%) patients were male. Anterior, inferior, and lateral infarctions were observed in 61 (62.9%), 28 (28.9%), and 8 (8.2%), respectively. The time from AMI to operation was <24 hours in 25 patients (25.8%), 1-7 days in 27 (27.8%), 8-21 days in 32 (33%), and >22 days in 13 (13.4%). Intra-aortic balloon pumping was used in 48 patients (49.5%). The mean number of anastomoses per patient was 4.0±1.2. There was no in-hospital mortality. Low output syndrome was observed in 7 patients (7.2%), stroke in 5 patients (5.2%), and respiratory failure in 7 patients (7.2%). The early graft patency rate was 98.5% (270/274 anastomoses), and 1-year patency rate was 90.5% (183/202 anastomoses). Ten patients (10.3%) underwent percutaneous coronary intervention, and the revascularization free survival rate was 86.9% at 7 years. Twenty patients (20.6%) died during follow-up, and actuarial survival rate was 68.5% at 7 years. Major adverse cardiovascular and cerebrovascular event free survival rate was 60.9% at 7 years. Cox proportional hazard analysis revealed that octogenarian and time from AMI to operation>=24hours were independent predictors of mortality (Table).
CONCLUSIONS: Off-pump CABG is a safe and effective procedure in patients with AMI.
Independent predictors of mortality in multivariate analysis
Clinical variableHazard ratio (95% confidence interval)p Value
Octogenerian6.333 (2.413-16.618)<0.001
Time from AMI to operation >=24hours6.266(1.375-28.566)0.018


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