Optimal Timing Of Off-pump Coronary Artery Bypass Surgery In Patients With Non-ST Elevated Myocardial Infarction

Objectives: Off-pump coronary artery bypass graft surgery(OPCAB)is one of most important approaches to the treatment of coronary atherosclerotic heart disease(CHD).However,at present,the relevant guidelines have not yet clarified the optimal timing of the OPCAB surgery for patients with Non-ST segment elevation myocardial infarction(NSTEMI).The purpose of this retrospective study is to determine the timing of OPCAB surgery in NSTEMI patients by analyzing the data of our center from 2009 to 2015.Methods: A retrospective study was performed in 261 NSTEMI patients who underwent isolated OPCAB surgery from May 2009 to May 2015 in our center.Those 261 patients with previous NSTEMI were categorized as Group A(cTn?>0.15 ng/ml,103 cases)and Group B(cTn??0.15ng/ml,158 cases).The age,left main lesion,cTn?> 0.15ng/ml,to perform surgery 10 days within NSTEMI,gender,BMI,smoking history,family history of coronary heart disease and other factors were analyzed by univariate analysis and multivariate analysis.The experiment design was according to 2x2 factorial experimental design,and the indexes were postoperative mortality,postoperative main adverse cardiovascular and cerebrovascular events(MACCEs)and postoperative hospital stay.There are two investigated factors: 10 days within NSTEMI and cTn? value above 0.15ng/ml.Results: All the patients successfully underwent off-pump coronary artery bypass surgery without transformed to extracorporeal circulation.Multivariate analysis showed that preoperative cTn?> 0.15ng/ml,surgery within 10 days after NSTEMI,age and left main coronary artery disease were predictors of MACCEs of 30-days after surgery(OR value,95%CI and values are: 5.115,1.355-19.313,0.016;4.421,1.121-17.434,0.034;1.205,1.072-1.353,0.002;4.191,1.832-9.589,0.001).There were 4 patients(3.9%)died in group A and 2 patients(1.3%)died in group B within 30 days after operation but failed to reach statistically significant(P> 0.05).Factorial analysis showed that the incidence of postoperative mortality and postoperative MACCEs were lower when performing surgery with cTn??0.15ng/ml.The incidence of postoperative mortality and postoperative MACCEs were lower and postoperative hospital stay was shorter when performing surgery 10 days after NSTEMI.And there was interaction between cTn??0.15ng/ml and performing surgery within 10 days after NSTEMI concerning to the MACCEs.Conclusion: It is safe to perform OPCAB surgery on NSTEMI patients.Preoperative cTn?> 0.15ng/ml,NSTEMI within 10 days after surgery,age and left main coronary artery disease were the predictors of ACCEs of 30-days after surgery.It is recommended to perform OPCAB surgery 10 days after NSTEMI with cTn? below 0.15ng/ml.