Optimal Timing of Coronary Artery Bypass Grafting in Hemodynamically Stable Patient After Myocardial Infarction and Definition of Poor Prognostic Factors. Pilot Study

Centre Hospitalier La Chartreuse

Status: Completed

Conditions: Cardiac Surgery

Treatments: Other: No intervention

Study type: Observational

Funder types: Other

Identifiers

NCT03863158

CCVT-ChloéBernard 2019

Details and patient eligibility

About

Acute coronary syndromes (ACS) represent the leading cause of death in France. Their incidence is increasing due to population aging and to the persistence of cardiovascular risk factors. Currently, revascularization surgery remains outside the emergency treatment, because early performed, it tends to lead to extension and hemorrhage of the infarcted area, because of the CPB, aortic clamping, cardioplegia, and other heart manipulation.

However, CABG are indicated as an emergency in some situations of STEMI: Threat of infarction of an extended territory without favorable anatomy to angioplasty, anatomy not favorable to angioplasty associated with cardiogenic shock or persistent ischemia, acute complications of myocardial infarction (massive mitral insufficiency, interventricular communication, parietal rupture) requiring surgery under CPB with concomitant bypass surgery or failure of angioplasty (proximal coronary dissection).

Operative mortality is high; 15 to 20% for patients operated 12 to 48 hours after AMI and 4-5% for those operated after 48 hours.

Nevertheless, it seems legitimate to study if there would be a place for primary surgical revascularization in case of patient with hemodynamically stable ACS, in order to limit myocardial ischemia, spread of necrosis, to limit the risk of recurrence, and the consequences of low cardiac output. Performing a complete early surgical revascularization could limit the ischemia-reperfusion syndrome and anticipate the occurrence of cardiogenic shock.

Full description

Trial on medical records only

Enrollment: 476 patients

Sex: All

Ages: 18 to 99 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients presenting acute myocardial infarction with hemodynamic stability at the diagnosis
• Patients undergoing coronary artery bypass in Dijon University hospital

Exclusion criteria

• Patients with Acute pulmonary oedema
• Patients with cardiorespiratory arrest before coronary angiography
• hemodynamically unstable patient at diagnosis
• patients requiring combined surgery
• patients with unstable angina