Clinical Effect And Related Hot Issues Of Coronary Artery Bypass Grafting In Patients With Acute ST Segment Elevation Myocardial Infarction

Objective:To investigate the clinical effect and related hot issues of coronary artery bypass grafting(CABG)in acute ST-segment elevation myocardial infarction(STEMI)Method:We retrospectively analyzed the clinical data and results of 206 patients who underwent CABG from January 2009 to January 2015 in Qingdao Municipal Hospital.There were 30 emergency/urgent surgeries(group A)including 15 cases of cardiogenic shock,4 cases with mechanical complications,9 cases with refractory ischemia,and 2 cases within 6 hours after the occurrence of STEMI.Stable STEMI patients who underwent CABG after acute myocardial infarction 1 week within 30 days had 66 cases(B group).Randomly selected 110 patients with non-myocardial infarction undergoing elective CABG in the same period.The general clinical data and coronary angiographic angiopathy were compared between the three groups.The operative time,mortality,number of grafts,use of intra-aortic balloon pump(IABP),duration of ICU stay,and complications were observed.Follow-up for 24 months after surgery.Result:The number of graft vessels ranged from 1 to 5,averaging at 2.82±0.89,and there was no statistically significant difference in the number of transplanted blood vessels between the three groups with 197 internal arteries(95.63%)applied.Within the30-day postoperative period,96 patients with STEMI had 11 deaths and a mortality rate of 5.34%.They died of circulatory failure,multiple organ failure,and renal failure.Among them,7 patients(23.3%)died in group A,2 patients(3.03%)died in group B and2 patients(1.82%)died in group C.There was a statistically significant difference between group A and group B or between group A and group C in mortality,postoperative complications(low cardiac output,multiple organ failure,arrhythmia)and the use of IABP(P<0.05).The difference between group B and group C was no significant(P>0.05).Significant differences among three groups(A、B、C)at ICU time [(7.4±2.4)d、(4.6±1.3)d、(3.6±1.5)d].A total of 183 patients were followed up 24 months with23 missing due to changes in the patient’s contact information and address.One patient died of cerebrovascular accident in group A,one patient died of a traffic accident in Group C and there was no death in group B during follow-up.Conclusion:CABG is safe for stable STEMI patients after 7 days of myocardial infarction within 30 days with full preoperative preparation and can improve the patients survival.The patients with cardiogenic shock,persistent myocardial ischemia and mechanical concurrency should receive the emergency CABG to save lives.Treating the severe high-risk STEMI patients by CABG is a reasonable and effective important revascularization method with the early application of IABP and should be widely used clinically.