J Korean Med Sci.  2012 Feb;27(2):153-159. 10.3346/jkms.2012.27.2.153.

Long Term Results of ST-Segment Elevation Myocardial Infarction versus Non-ST-Segment Elevation Myocardial Infarction after Off-Pump Coronary Artery Bypass Grafting: Propensity Score Matching Analysis

• Hong S
• Youn YN
• Yi G
• Yoo KJ

• KMID: 1120152
• DOI: http://doi.org/10.3346/jkms.2012.27.2.153

Abstract

There is no consensus as to which acute myocardial infarction subtype poses a greater risk after coronary artery bypass grafting (CABG). We compared the early and the long term results of off-pump coronary artery bypass grafting (OPCAB) between patients with STEMI (group I, n = 83), and NSTEMI (group II, n = 237). Group I had higher EuroSCORE, prevalence of emergency surgery, preoperative intra-aortic balloon pump use, preoperative emergency percutaneous transluminal coronary angioplasty, and preoperative thrombolytic use than group II. There were no significant differences in 30-day mortality and major adverse cardiac and cerebrovascular event (MACCE) between groups. Overall 8-yr survival was 93% and 87% in groups I and II, respectively. Freedom from MACCE after 8 yr was 92% and 93% in groups I and II, respectively. After propensity score matching analysis, there were no significant differences in preoperative parameters, postoperative in-hospital outcomes, and long-term clinical outcomes. Surgical results of OPCAB in patients with acute myocardial infarction show good results in terms of long-term survival and freedom from MACCE, with no significant differences in clinical outcomes between STEMI and NSTEMI groups.

Keyword

STEMI; NSTEMI; Coronary Artery Bypass Surgery; Off-Pump

MeSH Terms

Acute Disease
Aged
Angioplasty, Balloon, Coronary
*Coronary Artery Bypass, Off-Pump
Disease-Free Survival
Electrocardiography
Female
Fibrinolytic Agents/therapeutic use
Humans
Male
Middle Aged
Myocardial Infarction/drug therapy/mortality/*surgery
Odds Ratio
Preoperative Period
Propensity Score

Figure

• 

  Fig. 1 Survival curves after OPCAB in STEMI and NSTEMI. (A) Overall survival after OPCAB in STEMI and NSTEMI. Overall 8-yr survival was 93% and 87% in groups I and II, respectively (P = 0.07). (B) MACCE-free survival after OPCAB in STEMI and NSTEMI. Eight-year MACCE-free survival was 89.4% and 89.2% in groups I and II, respectively (P = 0.26). (C) Overall survival after OPCAB in STEMI and NSTEMI after propensity matching analysis. Overall 8-yr survival was 97% in each group after propensity score matching (P = 0.53). OPCAB, off-pump coronary artery bypass grafting surgery; STEMI, ST elevation myocardial infarction; NSTEMI, non-ST elevation myocardial infarction; MACCE, major cardiovascular and cerebrovascular event; BMI, body mass index; CABG, coronary artery bypass grafting; CI, confidence interval; CPB, cardiopulmonary bypass; EuroSCORE, European System for Cardiac Operative Risk Evaluation; IABP, intra-aortic balloon pump; AMI, acute myocardial infarction; OR, odds ratio; PTCA, percutaneous transluminal coronary angioplasty; SD, standard deviation.

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