Coronary artery bypass surgery within 48 hours after cardiac arrest due to acute myocardial infarction

Abstract

Objectives: Cardiac arrest (CA) in patients with acute myocardial infarction is associated with a poor prognosis. Due to the additional trauma, risk of stroke and lack of data, coronary artery bypass grafting (CABG) is a controversial revascularization strategy for patients who cannot be treated percutaneously. Against this background, we investigated the outcome of patients from our department with acute myocardial infarction undergoing CABG after CA.

Methods: Between January 2001 and January 2015, 129 patients with preoperative CA due to acute myocardial infarction underwent CABG at our institution within 48 h after the CA had occurred. Predictors of in-hospital and long-term mortality were analysed. Neurological outcome according to cerebral performance category scale was investigated.

Results: Sixty CA (47%) events occurred out-of-hospital. Ventricular fibrillation was the major underlying arrhythmia ( n = 92, 71%). The mean age was 65 ± 10 years. Eighty-four patients (65%) were diagnosed with ST-elevation myocardial infarction and 108 patients (84%) had 3-vessel coronary artery disease. Forty-three cases (33%) underwent percutaneous transluminal angioplasty. The median time to CABG was 4 (range 0.2-4) h. Complete revascularization was achieved in 106 patients (83%). The stroke rate was 9% ( n = 11) and hypoxic brain damage occurred in 16 patients (12%). Nine subjects (7%) needed extracorporeal life support. Four intraoperative deaths (3%) occurred; the 30-day mortality rate was 23% ( n = 30); the mortality rate during follow-up was 30% ( n = 27). A total of 79% ( n = 70) of patients discharged alive showed good neurological outcome according to the cerebral performance category scale.

Conclusions: Despite the reluctance to expose patients with CA to early CABG, our data indicate that the operative strategy may not be as unfavourable as suspected.

Keywords: Acute myocardial infarction; Cardiac arrest; Coronary artery bypass surgery.