Objective To investigate clinical outcomes and perioperative management of off-pump coronary artery bypass grafting （OPCAB） for patients following acute myocardial infarction （AMI）.?Methods?From January 2006 to March 2010， 239 consecutive patients underwent OPCAB on the 14-27 （20.55±3.91） d following AMI（AMI group）in Renji Hospital，School of Medicine of Shanghai Jiaotong University. Preoperative MB isoenzyme of creatine kinase
（CK-MB） level was （15.82±6.24） U/L and cardiac troponin I（cTnI） was （0.07±0.04） ng/ml. Clinical data of 406 patients without myocardial infarction history who underwent OPCAB during the same period were also collected as the control group for comparison.?Results?The 30-day mortality of AMI group was 2.51% （6/239）. The causes of death were circulatory failure in 4 patients， ischemic necrosis of lower extremity caused by intra-aortic balloon pump （IABP） in 1 patient and pneumonia with septic shock in 1 patient. Dopamine usage in AMI group was significantly higher than that of the control group （61.51% vs. 37.44%， P=0.001）. Intraoperative or postoperative IABP implantation was more common in AMI group， but there was no statistical difference between the two groups（P＞0.05） . Postoperative drainage and blood transfusion in AMI group were significantly larger than those of the control group （385.18±93.22 ml vs. 316.41±70.05 ml， P=0.022；373.68±69.54 ml vs. 289.78±43.33 ml， P=0.005， respectively）. But there was no statistical difference in re-exploration rate between the two groups （P＞0.05）. There was no statistical difference in the incidence of postoperative new onset atrial fibrillation between the two groups （P＞0.05）. Incidence of acute kidneyinjury of AMI group was significantly higher than that of the control group （13.81% vs. 8.62%， P=0.038）. Postoperative 30-day mortality of AMI group was higher than that of the control group， but there was no statistical difference between the two groups （2.51% vs. 1.48%，P＞0.05）. There was no statistical difference in ICU stay time and postoperative hospital stay between the two groups （2.01±0.95 d vs. 1.78±0.98 d；10.33±4.16 d vs. 9.89±4.52 d， respectively， P＞0.05）. A total of 211 patients （88.28%）in AMI group were followed up for 2.89±1.02 years， and 28 patients （11.72%） were lost during follow-up. Twenty-five patients died during follow-up including 14 cardiac deaths. One-year survival rate was 97.63%， and five-year survival rate was 88.15%.?Conclusion?It’s comparatively safe to perform OPCAB for patients at 2-4 weeks following AMI when their CK-MB and cTnI levels have returned to normal range.
Citation：
XIE Bo,XUE Song,LIAN Feng,HU Zhenlei,HUANG Ritai,LIU Sha.. Clinical Analysis of Off-pump Coronary Artery Bypass Grafting Following Acute Myocardial Infarction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 511-515. doi:
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- 1. Kushner FG， Hand M， Smith SC Jr， et al. 2009 Focused Updates：ACC/AHA Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction （updating the 2004 Guideline and 2007 Focused Update） and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention （updating the 2005 Guideline and 2007 Focused Update）：a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation， 2009， 120 （22）：2271-2306.
- 2. Voisine P， Mathieu P， Doyle D， et al. Influence of time elapsed between myocardial infarction and coronary artery bypass grafting surgery on operative mortality. Eur J Cardiothorac Surg， 2006， 29 （3）：319-323.
- 3. Lee DC， Oz MC， Weinberg AD， et al. Appropriate timing of surgical intervention after transmural acute myocardial infarction. J Thorac Cardiovasc Surg， 2003， 125 （1）：115-119.
- 4. Takai H， Kobayashi J， Tagusari O， et al. Off-pump coronary artery bypass grafting for acute myocardial infarction. Circ J， 2006， 70 （10）：1303-1306.
- 5. 袁忠祥， 刘健， 肖明第. 急性心肌梗死早期行冠状动脉旁路移植术疗效分析. 中华胸心血管外科杂志， 2007， 23 （3）：181-183．.
- 6. Christiansen S， Autschbach R. Results and treatment strategy for patients undergoing emergent coronary artery bypass grafting. Ann Thorac Cardiovasc Surg， 2010， 16 （3）：168-173.
- 7. Heusch G， Schulz R， Rahimtoola SH. Myocardial hibernation：a delicate balance. Am J Physiol Heart Circ Physiol， 2005， 288 （3）：H984-H999.
- 8. Weiss ES， Chang DD， Joyce DL， et al. Optimal timing of coronary artery bypass after acute myocardial infarction：a review of California discharge data. J Thorac Cardiovasc Surg， 2008， 135 （3）：503-511.
- 9. 高峰， 杨碧波， 马旭东， 等. 急性心肌梗死后冠状动脉旁路移植术时机选择. 中华胸心血管外科杂志， 2007， 23 （5）：308-310．.
- 10. Abd-Alaal MM， Alsabban MA， Abbas OA， et al. Timing of revascularization after acute myocardial infarction. Asian Cardiovasc Thorac Ann， 2010， 18 （2）：118-121.
- 11. Paparella D， Scrascia G， Paramythiotis A， et al. Preoperative cardiac troponin I to assess midterm risks of coronary bypass grafting operations in patients with recent myocardial infarction. Ann Thorac Surg， 2010， 89 （3）：696-702.
- 12. Møller CH， Penninga L， Wetterslev J， et al. Clinical outcomes in randomized trials of off-vs. on-pump coronary artery bypass surgery：systematic review with meta-analyses and trial sequential analyses.Eur Heart J， 2008， 29 （21）：2601-2616.
- 13. Dyub AM， Whitlock RP， Abouzahr LL， et al. Preoperative intra-aortic balloon pump in patients undergoing coronary bypass surgery：a systematic review and meta-analysis. J Card Surg， 2008， 23 （1）：79-86.
- 14. 谢波， 薛松， 黄日太， 等. 主动脉内球囊反搏在不停跳冠状动脉搭桥术围手术期的应用. 上海交通大学学报：医学版， 2009， 29 （4）：477-479.
- 15. Lekston A， Kurek A， Tynior B. Impaired renal function in acute myocardial infarction. Cardiol J， 2009， 16 （5）：400-406.
- 16. Dunning J， Versteegh M， Fabbri A， et al. EACTS audit and guidelines committee. Guideline on antiplatelet and anticoagulation management in cardiac surgery. Eur J Cardiothorac Surg， 2008， 34 （1）：73-92.
