Commentary: Coronary artery bypass grafting after acute myocardial infarction: Is timing of surgery a relevant factor?

Central MessageThe timing of coronary surgery after an acute syndrome appeares to be very important for the surgeons. But does it really matter?See Article page 2056. The matter? See How is artery bypass grafting (CABG) myocardial infarction (MI)? For many years we have been discussing this topic,1Lee D.C. Oz M.C. Weinberg A.D. Windsor T. Appropriate surgical intervention transmural infarction.J Thorac Cardiovasc Surg. 2003; 125: 115-120Abstract Full Text PDF PubMed Scopus (78) Google Scholar but still do not a predominant recommendation on when operate in patient MI, and most cases make ad hoc decisions. Moreover, confusing messages are coming from scientific literature. Although some studies would support delayed surgery,1Lee Scholar,2Weiss E.S. Chang D.D. Joyce D.L. Nwakanma L.U. Yuh Optimal infarction: review California discharge data.J 2008; 135: 503-511Abstract (99) other authors agree with this. This case study by Bianco colleagues3Bianco V. Kilic A. Gleason T.G. Aranda-Michel E. Wang Y. Navid F. et al.Timing may influence mortality readmissions.J 2021; 161: 2056-2064.e4Abstract (14) issue Journal. In retrospective single-center analysis, reviewed 8 experience type clinical scenario, concluding that there no significant differences between fast (<24 hours MI) (≥24 terms major adverse cardiovascular events (MACCE) mortality. reached their conclusions using stabilized inverse probability treatment weighting (IPTW), which one propensity score methods used diminish impact preoperative biases or often present analysis. At first sight, seems clear IPTW, 2 groups similar results; therefore, supported comparative I believe word caution should given. As shown Table E1,3Bianco characteristics patients before IPTW were significantly different aspects. you expect, less than 24 group was higher number undergoing operation emergency setting salvage operation, difference disappeared IPTW; observation applies Society Thoracic Surgeons IPTW. Given nature MI several aspects characterize its behavior, oversimplification these might represent mistake reporting outcomes. Surely sensible way minimize could outcome, certain intrinsic ignored. case, event interest itself, rather perhaps based pre-MI variables only. We forget patients, especially those undergo as last option, reflected E1 colleagues’ article.3Bianco Not surprisingly, overall population, operative almost double group, mitigated risk adjustments IPTW: danger here actually reduced negative role who at (ie, unstable patients) therefore improving outcome group. A published 20134Caceres M. Weiman D.S. infarction.Ann 2013; 95: 365-372Abstract (28) found only 39% previously articles demonstrated association outcomes, whereas such urgency presence angina consistently associated results: wrote “time itself unreliable criterion decide revascularization, acuity illness determinant outcomes.”4Caceres Despite this, report large population provide helpful insights. An feature article represented reported long-term MACCE has approached competing-risk analysis shows incidence MACCE, factors diabetes, peripheral vascular disease, chronic obstructive pulmonary prior heart failure, age predictors readmissions. Again, predictor status surgery. same time, show survival affected With remarkable 5-year 78.75% more 83.47% can certainly noted Cox proportional hazard model demonstrates reduction Another part related stratification (ST-segment elevation vs non–ST segment infarction), interesting note Supplemental 3 short-term rate prominent infarction. Overall, provided CABG convinced receive event? answer question our practice, further needed confirming thesis. advise end article, “the comorbidities plays determining outcomes MI.” am agreement statement. indication specific condition each patient, every carefully evaluated proceeding surgery, irrespective MI. Timing readmissionsThe Journal Cardiovascular SurgeryVol. 161Issue 6PreviewCoronary avoid increase postoperative morbidity hypothesized Full-Text