Commentary: Coronary artery bypass grafting after acute myocardial infarction: Sound clinical judgment still prevails

Central MessageContrary to long-held belief, this new study suggests that delaying surgical revascularization after acute myocardial infarction may not be desirable in all cases. However, further analyses will required confirm those conclusions.See Article page 2056. Contrary conclusions. See Despite numerous studies having focused on the outcomes of coronary artery bypass grafting (CABG) setting (AMI)—denoting a greater operative risk for emergency CABG compared with elective CABG—the optimal timing AMI remains controversial. In article, Bianco and colleagues1Bianco V. Kilic A. Gleason T.G. Aranda-Michel E. Wang Y. Navid F. et al.Timing influence mortality readmissions.J Thorac Cardiovasc Surg. 2021; 161: 2056-2064.e4Abstract Full Text PDF Scopus (14) Google Scholar report single-center, retrospective series short- long-term patients who underwent isolated within 24 hours from onset AMI. The interest relates its sizable cohort, comprising 2058 operated between 2011 2017, length follow-up, median approximately 2 years. authors clinical 292 <24 1766 had ?24 Although perioperative unadjusted patient cohorts was significantly group, there no such difference adjustment by propensity matching. concluded increase stability always beneficial. has limitations must considered before observation guides mainstream practice. First, were probably assumed have due their increased level acuity, resulting confounding indication through selection whose upfront been “worth it.” matching can limit differences, it cannot account potential confounders or treatment allocation biases. Conversely, deferred other comorbidities halted surgery. study, grading how stable versus much ischemia territory at present well defined, failure done makes comparison groups difficult. Surgeons often use intricate balance determine whether given should undergo now wait status stabilize action platelet inhibitors abate. relevance 24-hour cutoff also needs validation. Previous work Lee colleagues2Lee D.C. Oz M.C. Weinberg A.D. Lin S.X. Ting W. Optimal revascularization: transmural nontransmural infarction.Ann 2001; 71 (discussion 1202-4): 1197-1202Abstract PubMed (75) Scholar,3Lee Appropriate intervention infarction.J 2003; 125 119-20): 115-119Abstract (78) Weiss colleagues4Weiss E.S. Chang D.D. Joyce D.L. Nwakanma L.U. Yuh infarction: review California discharge data.J 2008; 135 (511.e1-3): 503-511Abstract (99) reported differences using cutoffs 6 3 days post-AMI, respectively. Therefore, subdivisions around could revealed outcome study. Further, died eventually became too sick captured. future, novel approaches as serological markers including troponin C-reactive protein help define appropriate intervention.5Beller J.P. Hawkins R.B. Mehaffey J.H. LaPar D.J. Kron I.L. Yarboro L.T. al.Does preoperative impact grafting?.Ann 2018; 106: 46-51Abstract (11) Scholar,6Kosmidou I. Redfors B. Chen S. Crowley Lembo N.J. Karmpaliotis D. al.C-reactive prognosis percutaneous graft surgery left main disease: analysis EXCEL trial.Am Heart J. 2019; 210: 49-57Crossref (10) Until randomized trial addressing question takes place, sound judgment continue form rationale basis defining Timing readmissionsThe Journal Thoracic Cardiovascular SurgeryVol. 161Issue 6PreviewCoronary is delayed avoid an postoperative morbidity mortality. We hypothesized consistently associated outcomes. Full-Text