Optimal Timing of Surgical Revascularization for Myocardial Infarction and Left Ventricular Dysfunction

Background： The optimal timing of surgical revascularization for patients presenting with ST-segment elevation myocardial infarction （STEMI） and impaired left ventricular function is not well established. This study aimed to examine the timing of surgical revascularization after STEMI in patients with ischemic heart disease and left ventricular dysfunction （LVD） by comparing early and late results. Methods： From January 2003 to December 2013, there were 2276 patients undergoing isolated coronary artery bypass grafting （CABG） in our institution. Two hundred and sixty-four （223 male, 41 females） patients with a history of STEMI and LVD were divided into early revascularization （ER, 〈3 weeks）, mid-term revascularization （MR, 3 weeks to 3 months）, and late revascularization （LR, 〉3 months） groups according to the time interval from STEMI to CABG. Mortality and complication rates were compared among the groups by Fisher＇s exact test. Cox regression analyses were performed to examine the effect of the time interval of surgery on long-term survival. Results： No significant differences in 30-day mortality, long-term survival, freedom from all-cause death, and rehospitalization for heart failure existed among the groups （P 〉 0.05）. More patients in the ER group （12.90%） had low cardiac output syndrome than those in the MR （2.89%） and LR （3.05%） groups （P = 0.035）. The mean follow-up times were 46.72 ± 30.65, 48.70 ± 32.74, and 43.75 ± 32.43 months, respectively （P = 0.716）. Cox regression analyses showed a severe preoperative condition （odds ratio = 7.13, 95% confidence interval 2.05-24.74, P = 0.002） rather than the time interval of CABG （P 〉 0.05） after myocardial infarction was a risk factor of long-term survival. Conclusions： Surgical revascularization for patients with STEMI and LVD can be performed at different times after STEMI with comparable operative mortality and long-term survival. However, ER （〈3 weeks） has a higher incidence of postoperative low cardiac output syndrome. A severe preoperative condition rather than the time interval of CABG after STEMI is a risk factor of long-term survival.

Surgical Management for a Broken Delivery Shaft in <i>Vivo</i>during PCI Following Acute Myocardial Infarction in a Complex LAD Artery Lesion: A Case Report and Literature Review

Stuck up and fracture of coronary angioplasty hardware are unwonted complications of percutaneous coronary interventions (PCI) for which surgical retrieval and management is once in a while required. We present one case of a 59-year-old diabetic, a hypertensive gentleman who attended the emergency room (ER) with central chest pain for 2 hours. After evaluation of the patient by physical and noninvasive diagnostic tests, he was diagnosed as a case of acute myocardial infarction (AMI) with stable hemodynamic. For the aforementioned findings, the patient was treated first with a thrombolytic agent in ER and then shifted to Cardiology Department for monitoring and further coronary evaluation by coronary angiography (CAG). CAG revealed essentially single vessel disease (SVD) with complex left anterior descending (LAD) artery lesion, so PCI was attempted but failed with an unfortunate incidence of the broken delivery shaft and left in vivo. Immediate decision making and surgical management for retrieval of lost angioplasty device and correction coronary lesion with revascularization save the patient from grave complication. All the series of events and management approaches of this very complex coronary artery lesion are discussed in this article.