Clin Res Cardiol 96:Suppl 2 (2007)

P359 - Treatment of ST-Elevation myocardial infarction - The Role of the Cardiac Surgeon
 
C. Hagl1, N. Khaladj1, S. Peterss1, A. Martens1, M. Strüber1, A. Simon1, A. Haverich1, M. Shrestha1
 
1Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover;
 
Introduction: Surgical treatment of patients with ongoing myocardial infarction is still a matter of controversy. The clinical outcome of patients who were untreatable or rejected by the referring cardiologists has not been evaluated so far.
Methods: Between 2003 and 2006, 72pts, mean age of 65 years (R: 45-80) underwent CABG within the first 24 hours of STEMI. 19 pts (26.3%) suffered from cardiogenic shock, 9 (12.5%) had prior CPR, while the remaining showed an unstable angina. Preoperative support by IABP was initiated in 3 pts (4.1%). 45 pts (62.5%) had a left main stenosis.
Results: All patients showed a significant elevation of cardiac markers (CKMB / troponin T) and ST elevation. The mean number of grafts was 2.5 (R: 1-4). The CBP-time ranged from 41 to 270 min. IABP for weaning from ECC was used in 23 pts (32%), one patient needed ECMO support. Postoperative complications included, rethoracotomy for bleeding in 2 (2.7%), stroke in 2 (2.7%) and temporary neurologic disorder in 9 (12.5%). 30-day-mortality mortality was 12.5% (n=9) in the whole group, 37% (7/19) in the group with cardiogenic shock and 3.8% (2/53) in those without signs of hemodynamic deterioration (p<0.05).
Conclusion: Emergency CABG in patients with acute myocardial infarction can be performed with remarkable results, especially in those without cardiogenic shock. Therefore, operative revascularization should not only be considered as a rescue therapy but also as a reasonable alternative to acute PCI. These results may have an impact on future treatment algorithms - interventional vs surgical - in this difficult subset of patients with acute coronary syndromes.
 

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