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Canadian Journal of Cardiology

Did we “OBTAIN” new insights for optimal timing of CABG and survival after acute myocardial infarction?

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 surgery (CABG), 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, heart failure (HF) or angina post-AMI, but the optimal timing of such surgical coronary revascularization in more stable or less symptomatic AMI patients 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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      References

        • Raghavan R.
        • Benzaquen B.S.
        • Rudski L.
        Timing of bypass surgery in stable patients after acute myocardial infarction.
        CJC. 2007 Oct; 23: 976-982
        • 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.
        CJC Open. 2021 May; 3: 1051-1059
        • 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.
        CJC. 2022 Nov; (**)
        • Ye Q.
        • Zhang J.
        • Ma L.
        Predictors of all-cause 1-year mortality in myocardial infarction patients.
        Medicine (Baltimore). 2020 Jul 17; 99e21288
        • Ngaage D.L.
        • Sogliani F.
        • Tang A.
        Early and late prognostic implications of coronary artery bypass timing after myocardial infarction.
        Eur J Cardiothorac Surg. 2013; 43: 549-554
        • Senanayake E.L.
        • Howell N.J.
        • Evans J.
        • et al.
        Contemporary outcomes of urgent coronary artery bypass graft surgery following non-ST elevation myocardial infarction: urgent coronary artery bypass graft surgery consistently outperforms Global Registry of Acute Coronary Events predicted survival.
        Eur J Cardiothorac Surg. 2012; 41: e87-91
        • Braxton J.H.
        • Hammond G.L.
        • Letsou G.V.
        • et al.
        Optimal timing of coronary artery bypass graft surgery after acute myocardial infarction.
        Circulation. 1995; 92: II66-I68
        • Thilak A.P.
        • Thacker D.
        • Shales S.
        • et al.
        Timing of coronary artery bypass grafting after acute myocardial infarction: does it influence outcomes?.
        Kardiochir Torakochirurgia Pol. 2021; 18: 27-32
        • Sintek C.F.
        • Pfeffer T.A.
        • Khonsari F.
        Surgical revascularization after acute myocardial infarction. Does timing make a difference?.
        J Thorac Cardiovasc Surg. 1994; 107: 1317-1322
        • Deeik R.K.
        • Schmitt T.M.
        • Ihrig T.G.
        • Sugimoto J.T.
        Appropriate timing of elective coronary artery bypass graft surgery following acute myocardial infarction.
        Am J Surg. 1998; 176: 581-585
        • Kennedy J.W.
        • Ivey T.D.
        • Misbach G.
        • et al.
        Coronary artery bypass graft surgery early after acute myocardial infarction.
        Circulation. 1989; 79: I73-I78
        • Lee D.C.
        • Oz M.C.
        • Weinberg A.D.
        • Lin S.X.
        • Ting W.
        Optimal timing of revascularization: Transmural versus nontransmural acute myocardial infarction.
        Ann Thorac Surg. 2001; 71: 1198-1204
        • Naylor C.D.
        • Szalai J.P.
        • Katic M.
        Benchmarking the vital risk of waiting for coronary artery bypass surgery in Ontario.
        CMAJ. 2000; 162: 775-779
        • Basir M.B.
        • Kapur N.K.
        • Patel K.
        • et al.
        National Cardiogenic Shock Initiative Investigators. Improved outcomes associated with the use of shock protocols: Catheter.
        Cardiovasc Interv. 2019; 93: 1173-1183
        • Tehrani B.N.
        • Truesdell A.G.
        • Sherwood M.W.
        • et al.
        Standardized team-based care for cardiogenic shock.
        J Am Coll Cardiol. 2019; 73: 1659-1669
        • Tomas R.
        • Greenwood K.L.
        • Glaser D.
        Sex differences in acute myocardial infarction hospital management and outcomes.
        J Cardiovasc Nurs. 2018; 33: 568-575
        • Cenko E.
        • Yoon J.
        • Kedev S.
        • et al.
        Sex differences in outcomes after STEMI: Effect modification by treatment strategy and age.
        JAMA Intern Med. 2018; 178: 632-639
        • Ubrich R.
        • Barthel P.
        • Haller B.
        • et al.
        Sex differences in long-term mortality among acute myocardial infarction patients: Results from the ISAR-RISK and ART studies.
        PLoS ONE. 2017; 12e0186783
        • Graham G.N.
        • Jones P.G.
        • Chan P.S.
        • et al.
        Racial disparities in patient characteristics and survival after acute myocardial infarction.
        JAMA Netw Open. 2018; 1e184240
        • Chi G.C.
        • Kanter M.H.
        • Li B.H.
        • et al.
        Trends in acute myocardial infarction by race and ethnicity.
        JAHA. 2020; 9e013542
        • Garcia M.
        • Almuwaqqat Z.
        • Moazzami K.
        • et al.
        Racial disparities in adverse cardiovascular outcomes after a myocardial infarction in young or middle-aged patients.
        JAHA. 2021; 10e020828
      1. Henning H, Gilpin EA, Covell JW, et al. Prognosis after myocardial infarction: A multivariate analysis of mortality and survival. 1979;59(6):1124-1136.

        • Gudnadottir G.S.
        • Andersen K.
        • Thrainsdottir I.S.
        • et al.
        Gender differences in coronary angiography, subsequent interventions, and outcomes among patients with acute coronary syndromes.
        Am Heart J. 2017; 191: 65-74
        • Isorni M.A.
        • Blanchard D.
        • Teixeira N.
        • et al.
        Impact of gender on use of revascularization in acute coronary syndromes: the national observational study of diagnostic and interventional cardiac catheterization (ONACI).
        Catheter Cardiovasc Interv. 2015; 86: E58-65

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