SURGICAL REVASCULARIZATION IN ACUTE MYOCARDIAL INFARCTION
Ojas Superspeciality Hospital, Panchkula, India, CHANDIGARH, India.
OBJECT: CABG in Acute MI is a challenging task but at the same time desired also many times. It sans any guidelines. This study defines the modalities available, timing and outcomes
METHODS: 1040 patients were taken up for CABG in Acute Myocardial infarction situation when coronary anatomy was not suitable to PCI. The patients were categorized into stable and unstable category and offered on pump or off pump CABG, in stable patients with Non Q Mi they were offered surgery on 3rd day and Q MI patients were offered surgery on 7th day. Unstable patients were offered surgery with in 8 hrs of MI or 8 to 72 hrs of MI.988 Stable patients were offered Off pump CABG and 52 unstable patients were subjected to On pump surgery. IABP was used as adjunct in 90% cases.
RESULTS: Total mortality ranged from 2.5% in off pump group and 6% in On pump group. LV function improved maximum in with in 8 hrs group followed by after 7 days group. 8 to 72 hrs group was having maximum mortality, prolonged ventilation, high inotropes and renal complication
CONCLUSIONS: CABG can be offered safely in acute MI situation with off pump technique. The mortality is comparable to elective CABG. The timing is very important and choice of On pump if patient is very unstable. IABP is an imp tool to have good outcomes.
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