Document Detail


Appropriate timing of surgical intervention after transmural acute myocardial infarction.
MedLine Citation:
PMID:  12538993     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Recommended timing of coronary revascularization after transmural acute myocardial infarction ranges from immediate surgical intervention to repair 4 weeks after infarction. Such wide variation has created a dilemma in the management of these patients. The objective of this study was to delineate the optimal timing of revascularization after transmural acute myocardial infarction in a large and contemporary patient population. METHODS: We performed a retrospective multicenter analysis of 32,099 patients who underwent coronary artery bypass grafting as the sole procedure after transmural myocardial infarction between 1991 and 1996 by 179 surgeons at 33 hospitals in New York State. RESULTS: Overall hospital mortality for all patients who underwent coronary revascularization with a history of transmural myocardial infarction was 3.3%. Hospital mortality decreased with increasing time interval between revascularization and transmural acute myocardial infarction: 14.2%, 13.8%, 7.9%, 3.8%, 2.9%, and 2.7% for less than 6 hours, 6 hours to 1 day, 1 to 3 days, 4 to 7 days, 7 to 14 days, and greater than 15 days, respectively. Multivariate analyses of 43 potential risk factors suggests that revascularization within 3 days of transmural acute myocardial infarction is independently associated with mortality. CONCLUSIONS: Coronary revascularization within 3 days of a transmural acute myocardial infarction might be an added risk for mortality. In the absence of absolute indications for emergency surgical intervention, such as structural complications and ongoing ischemia, a 3-day waiting period before surgical revascularization should be considered.
Authors:
Daniel C Lee; Mehmet C Oz; Alan D Weinberg; Windsor Ting
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  125     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-01-22     Completed Date:  2003-02-12     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  115-9; discussion 119-20     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, College of Physicians and Surgeons, Columbia University, New York City, NY 10032, USA. cd164@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Artery Bypass*
Female
Hospital Mortality
Humans
Male
Multivariate Analysis
Myocardial Infarction / mortality*,  surgery*
Retrospective Studies
Risk Factors
Time Factors

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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