Coronary Artery Bypass Grafting in Patients with Acute Myocardial Infarction: Is Off-Pump Worse?

Background: Although there are some potential benefits of off-pump coronary bypass grafting (OPCAB) versus an on-pump surgery, the role of OPCAB for surgical treatment of acute myocardial infarction (AMI) is still a matter of debate. In this study, we evaluated short-term outcome of OPCAB compared with on-pump coronary artery bypass grafting (ONCAB) in patients with AMI.

Method: A total of 423 patients with AMI, defined as less than 48 hours since onset of symptoms and/or diagnosis were surgically treated at our center, between January 2010 and February 2020 and retrospectively analyzed. These patients were divided into two groups, either OPCAB (n = 260, 61.5%) or ONCAB (n = 163, 38.5%). A logistic regression model was used for statistical analysis.

Results: There was a higher rate of comorbidities within the OPCAB group, which resulted in an elevated EuroSCORE II (mean (%): OPCAB versus ONCAB: 4.6 ± 3.4 versus 3.7 ± 3.0 (p < 0.001) and a higher rate of ST-elevated myocardial infarction (STEMI) (OPCAB: 28.8% vs. ONCAB: 23.5%, p < 0.001). However, no significant differences in terms of complete revascularization, 30-day mortality, remyocardial infarction, stroke, acute renal injury, bypass revision, prolonged ventilation or catecholamine-support, and use of mechanical circulatory support (MCS) were identified. 16 (9.8%) patients from OPCAB group were converted to on-pump procedure.

Conclusion: The in-hospital outcome of OPCAB in patients with AMI was not significantly different or inferior to on-pump CABG. Complete revascularization was performed safely and effectively without use of cardiopulmonary bypass in the majority of patients with AMI at our center.

Publikationsverlauf

Artikel online veröffentlicht:
28. Januar 2023