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Canadian Journal of Cardiology

Did We “OBTAIN” New Insights for Optimal Timing of CABG and Survival After Acute Myocardial Infarction?

  • Varinder K. Randhawa
    Correspondence
    Corresponding author: Dr Varinder K. Randhawa, Critical Care and Heart Failure Transplant Cardiology, University of Toronto, Temerty Faculty of Medicine, and Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada. Tel.: 416-480-6100.
    Affiliations
    Department of Critical Care Medicine, Sunnybrook Health Science Centre, Toronto, Ontario, Canada

    Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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  • Daniel Kim
    Affiliations
    Department of Cardiology, Mazankowski Alberta Heart Institute and University of Alberta, Edmonton, Alberta, Canada
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  • Rakesh Arora
    Affiliations
    Harrington Heart Vascular Institute, University Hospitals, Cleveland, Ohio, USA

    Case Western Reserve University, Cleveland, Ohio, USA
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  • Fuad Moussa
    Affiliations
    Department of Cardiac Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Published:November 22, 2022DOI:https://doi.org/10.1016/j.cjca.2022.11.007
      Despite decades of therapeutic advancements in coronary revascularization—whether by thrombolysis, percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG) surgery—and hemodynamic support with temporary mechanical circulatory support (tMCS) for those with further complication of shock, acute myocardial infarction (AMI) remains a leading cause of death in Canada and worldwide.
      • Raghavan R.
      • Benzaquen B.S.
      • Rudski L.
      Timing of bypass surgery in stable patients after acute myocardial infarction.
      ,
      • Ko D.T.
      • Ahmed T.
      • Austin P.C.
      • et al.
      Development of acute myocardial infarction mortality and readmission models for public reporting on hospital performance in Canada.
      Nearly 70,000 Canadians suffer from AMI, and 5000 die annually within 30 days of admission.
      • Ko D.T.
      • Ahmed T.
      • Austin P.C.
      • et al.
      Development of acute myocardial infarction mortality and readmission models for public reporting on hospital performance in Canada.
      Emergent CABG is still indicated for those patients with mechanical complications or severe ventricular failure leading to refractory cardiogenic shock (CS), heart failure (HF), or angina post-AMI, but the optimal timing of such surgical coronary revascularization in more stable or less symptomatic patients with AMI remains unclear. The study by Goldberger and colleagues published in this issue of the Canadian Journal of Cardiology
      • Fernandes G.C.
      • Kovacs R.
      • Abbott J.D.
      • et al.
      Determinants of early and late in-hospital mortality after acute myocardial infarction: a sub-analysis of the OBTAIN registry.
      raises several intriguing and yet unanswered questions: whether risk factors for in-hospital mortality after AMI evolve over time during index hospitalization, whether any identifiable risk factors for death are potentially modifiable, and whether there is an optimal timing for CABG after AMI.
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