Operative Myokardrevaskularisation nach Myokardinfarkt innerhalb von 48 Stunden
Background: The actual results of treatment of acute myocardial infarction (AMI)have not significantly improved even though much effort has been invested to restructure and reorganize emergency systems in western industrial nations. Current treatment concentrates on immediate revascularization by means of fibrinolytic treatment or percutaneous coronary intervention (PCI) : the role of coronary bypass surgery in AMI is still not clearly defined. Methods. Between January 2000 and November 2007, 277 consecutive patients with angiographically confirmed multivessel disease and AMI received coronary bypass surgery within 48 hours of diagnosis. The data were retrieved from a prospective cardiovascular hospital database. Results. The overall in-hospital mortality was 14.8%, 24.1% in patients with cardiogenic shock (CS), and 6.3% without CS. Forty eight percent of 277 patients were in preoperative CS, 35.9% required an intra-aortic balloon pump (IABP), and 26.8% were treated with inotropes or vasopressive medication. The median time from AMI to surgery was 10±4 hours. All patients received complete revascularization (overall number of grafts: 3.2±0.9; arterial grafts: 1.1±0.6; venous grafts: 2.1±0.9). After multivariate modelling, the following predictors of the elevated in-hospital mortality have been identified : preoperative use of inotropes and vasopressive medication (Odds Ratio (OR) 5.4, P<0.001), postoperative renal failure requiring continuous veno-venous hemodialysis (CVVHD) (OR 5.9, P<0.001), and peripheral vessel disease (OR 7.0, P<0.001). The median interval to discharge was 10 days. Conclusion. The obtained in-hospital mortality in patients with AMI and cardiogenic shock appeared superior after bypass surgery compared to actual results reported for PCI or medical treatment. In patients without CS, mortality was not essentially different from nationwide annual reports even in the first 48 hours after AMI.