Comparison Of Timing And Prognosis Of Coronary Artery Bypass Grafting In Different Types Of Acute Myocardial Infarction

Objective:To explore the short-term effect and long-term prognosis of coronary artery bypass grafting in patients with different types of acute myocardial infarction.Methods:The perioperative data of 93 patients with AMI who underwent CABG in the affiliated Hospital of Hebei University from January 2011 to June 2020 were collected.According to the elevation of ST segment before or after admission,the 93 patients were divided into ST segment elevation myocardial infarction group and non-St segment elevation myocardial infarction group.According to the period from the occurrence of STEMI to the operation day,all the subjects were divided into three groups: 10 in group A(8-14 days),11 in group B(15-21 days),17 in group C(22-30 days),and 11 in group D(8-14 days),20 in group E(15-21 days)and 24 in group F(22-30 days)according to the period from the occurrence of NSTEMI to the operation day.The preoperative data and intraoperative data(sex,age,smoking history,hypertension,diabetes,hyperlipidemia,old myocardial infarction,number of bridging vessels,length of operation,etc.),postoperative complications(atrial fibrillation,ventricular fibrillation,rethoracotomy,fat liquefaction,postoperative myocardial infarction,pulmonary infection,postoperative stroke and hospital death,etc.)and mediumand long-term prognosis(all-cause mortality,recurrent myocardial infarction,stroke,etc.)of patients with STEMI and NSTEMI were compared.Then the preoperative and intraoperative data,postoperative complications and medium-and long-term prognosis of STEMI and NSTEMI of CABG at the same time were compared,and the efficacy of surgical treatment of different types of acute myocardial infarction was evaluated.The patients were followed up for 6months to 10 years after discharge.The end points of follow-up were as follows: major cardio-cerebrovascular adverse events,(included death,non-fatal myocardial infarction,revascularization,stroke).Results:(1)The duration of operation and c Tn I on the first day after operation in);A group were significantly higher than those in group B and group C(P< 0.05).There was no significant difference in the other incidences of preoperative and postoperative complications and long-term survival without MACCE among groups A,B and C(P < 0.05).(2)There was no significant difference in preoperative and intraoperative condition,incidence of postoperative complications and long-term MACCE-free survival time among groups D,E and F(P > 0.05).(3)There was significant difference in postoperative complications between STEMI group and NSTEMI group,and there was no significant difference in MACCE-free survival time between STEMI group and NSTEMI group by Log-rank test.Conclusion:(1)The different operation time did not cause the difference of postoperative effect among the patients who received CABG at the 2nd,3rd and 4th week after the occurrence of STEMI;(2)The different operation time did not cause the difference of operation effect for the patients who received CABG within the 2nd,3rd and 4th week after the occurrence of NSTEMI.(3)The incidence of postoperative complications in STEMI group was higher than that in NSTEMI group,and there was no significant difference in medium and long-term prognosis.