Timing of Surgical Revascularization in Patients with Acute Myocardial Infarction: Results of a Single-Center Experience from the GERMIN-SURG Registry

Objectives: Optimal timing of coronary artery bypass grafting (CABG) in acute myocardial infarction (AMI) is still controversially discussed. As irreversible decline in cardiac function could be a result of delayed revascularization, concise information for decision-making is of utmost importance. Here, we present our experience from the GERMIN-SURG registry to evaluate indication and optimal timing of CABG in AMI.

Methods: In our multicenter observational study, we included AMI patients undergoing CABG surgery between 2017 and 2019. In this registry, patients were divided in two groups (A: CABG ≤48 hours after AMI; B: CABG after >48 hours). A total of 90 items of pre-, intra- and postoperative parameters were examined. Also, the 30-day mortality was evaluated. The χ ² test, Fisher's exact tests, independent t-test, and Mann–Whitney U-test were used when appropriate. Statistical significance was assumed at p < 0.05.

Result: A total of 158 patients were included in the study (A: n = 73; B: n = 85). Most of all patients presented with NSTEMI (77.2% vs. STEMI: 22.8%). No differences were observed as to baseline clinical data. Group A showed a higher EuroSCORE II (A: 6.8 ± 7.0%; B: 4.1 ± 6.0%; p < 0.001). In group A, a high incidence of persistent symptoms of angina, complex coronary artery disease (CAD) including left main stenosis, and STEMI were found. Also, serum markers of cardiomyocyte damage, for example, high sensitive troponin-T (hs-TnT), creatinine kinase, and CK-MB were higher compared with patients in group B. In group B, stable clinical condition and less complex CAD led to delayed surgery. Moreover, no significant differences concerning intra- and postoperative data were observed between the groups. Importantly, stroke rate and 30-day mortality were higher in group B (stroke: A: 1.4 vs. B: 7.1%; p = 0.123; 30-day mortality: A: 2.7 vs. B: 5.9%; p = 0.726).

Conclusion: Despite higher risk of AMI, early CABG surgery showed similar results compared with clinically stable patients with delayed surgery. First results form GERMIN-SURG registry indicate that early CABG in AMI patients may not be as unfavorable as suspected. The data of the other participating centers are needed to confirm our preliminary results.

Publication History

Article published online:
19 February 2021