Non-ST elevation myocardial infarction? Intervene!

opposed to the medically treated patients. The current guidelines also indicate that the GRACE score should be used as a tool in making this decision, and I think this study shows that surgery does provide a better outcome for patients, particularly in the higher risk groups with a GRACE-predicted score of over 10%. And the current guidelines recommend reintervention for patients with a predicted mortality of over 3%. So we are addressing the patients with higher risk and showing that surgery may benefit these patients to a greater extent. Dr. Vonk: So what you’re saying is that we should apply a slightly more aggressive conclusion on the GRACE score in an individual patient? Dr Senanayake: Yes. Dr K. Sarkar (Calcutta, India): Do you think in your Group 3 patients the incremental mortality could be addressed a little bit with techniques of myocardial protection? In other words, avoiding global ischaemia by considering on-pump beating heart or intra-aortic balloon-assisted off-pump? I mean, the imposition of global ischaemia in these category Group 3 patients, is it adding onto the risk factor? Dr Senanayake: I agree with your comments. The first comment that I would make is that the Group 3 patients were a small number; we had only 15 patients in that group. So this is something that we could look into in the future to prospectively collect more data in these high-risk groups. The practice in our Trust and in our department is to perform all surgery on-pump, so this is data that I can’t comment on, but there might be a beneficial role for what you suggested. Dr Sarkar: And I wasn’t really clear on your technique of cardioplegia. Was it antegrade, retrograde or was it just antegrade? Dr Senanayake: All patients had antegrade cardioplegia, but the difference between surgeons is between warm and cold blood cardioplegia, but it is all antegrade on-pump. Dr Sarkar: There was no retrograde used? Dr Senanayake: No. Dr G. Wimmer-Greinecker (Bad Bevensen, Germany): One question. You showed us that patients who had surgery up to 30 days after NSTEMI were included, and you said this was the index admission. So what was the reason for such a long hospital stay until they finally got their treatment? Dr Senanayake: All patients were within the index admission. There was variability depending on what time the surgery was performed from the time they were admitted. It’s difficult to comment on whether this would have caused a difference in their outcome. But particularly, the difficulty that we have is performing these surgeries within a short amount of time due to the pressure within the department. Dr Wimmer-Greinecker: So that’s a logistical issue? Dr Senanayake: Yes.