Early Versus Delayed Revascularization in Myocardial Infarction Patients: A Propensity-Matched Analysis Stratified by Ventricular Function

Background: Early revascularization during acute myocardial infarction (AMI) limits ischemia and salvages myocardium. Nevertheless, the prolonged time to surgery in multivessel disease questions the efficacy of early surgical intervention. This study aims to assess the outcomes of early (≤24 hours) versus late (>24 hours) surgical revascularization in AMI patients with normal and diminished (<30%) left ventricular ejection fraction (LVEF).

Methods: We performed a retrospective analysis of 1227 AMI patients treated from January 2016 to February 2023. Patients were categorized based on admission LVEF (Normal and Low LVEF) and further divided into early and late revascularization subgroups. To achieve balanced subgroups, propensity score matching was applied, considering 28 variables.

Results: The matching yielded 278 pairs in the normal LVEF group and 42 in the low LVEF group. The subgroups within both normal and low LVEF groups were comparable, although the ≤24 hours group within patients with normal LVEF had significantly higher Euro Score. Nevertheless, the in-hospital mortality and long-term survival was comparable between subgroups both in normal and low LVEF group. Almost half of the patients in low LVEF group presented in cardiogenic shock. In patients with normal LVEF, early revascularization did not improve LVEF, but in patients with low LVEF, the early revascularization resulted in significantly greater improvement of the LVEF.

	Normal LVEF		p	Low LVEF		p
	Early	Late		Early	Late
Euro Score	8.2 ± 10.1	5.0 ± 6.4	<0.01	20.3 ± 13.9	22.5 ± 14.5	n.s.
Shock, n (%)	34 (12%)	36 (13%)	n.s.	20 (48%)	20 (48%)	n.s.
OPCAB, n (%)	231 (83%)	236 (85%)	n.s.	15 (35%)	13 (31%)	n.s.
Mortality, n(%)	13 (4.7%)	7 (2.5%)	n.s.	8 (19.0%)	5 (11.9%)	n.s.
LVEFpre (%)	48.3 ± 8.5	49.9 ± 8.8	<0.05	25.8 ± 4.7	24.1 ± 5.8	n.s.
LVEFpost (%)	50.1 ± 9.3	50.4 ± 9.5	n.s.	37.6 ± 9.0	31.6 ± 10.1	<0.01
LVEFdiff (%)	1.9 ± 8.9	0.7 ± 8.2	n.s	11.8 ± 10.1	7.4 ± 7.7	<0.05

Conclusion: Early revascularization appears not to confer mortality and long-term survival advantages. However, it significantly enhances LVEF in patients with reduced baseline levels. The findings advocate for further randomized trials to elucidate whether AMI patients might benefit from early surgical intervention even beyond the initial hours postinfarction.

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2024