PDF(Pubmed)
Abstract：
BACKGROUND: Acute myocardial infarction (AMI) is a major global health concern. However, the optimum timing of coronary artery bypass grafting (CABG) in AMI patients remains controversial. This study investigated the optimal timing of CABG and its impact on postoperative outcomes. We hypothesized that determining the optimal timing of CABG could positively impact postoperative outcomes.
METHODS: We conducted a nationwide retrospective analysis of the National Health Insurance Service of Korea database, focusing on 1 705 843 adult AMI patients diagnosed between 2007 and 2018 who underwent CABG within 1 year of diagnosis. Patients were categorized based on CABG timing. Primary endpoints included cohort identification and the time interval from AMI diagnosis to CABG. Secondary endpoints encompassed major adverse cardiac and cerebrovascular events (MACCEs) and the impact of postoperative medications.
RESULTS: Of the patients, 20 172 underwent CABG. Surgery within 24 h of AMI diagnosis demonstrated the most favorable outcomes, reducing cardiac death, myocardial infarction recurrence, and target vessel revascularization. Delayed CABG within 3 days also outperformed surgery within 1-2 days post-AMI. Additionally, postoperative aspirin use was associated with improved MACCE outcomes.
CONCLUSIONS: CABG within 24 h of AMI diagnosis was associated with significantly minimized myocardial injury, emphasizing the critical role of rapid revascularization. Delayed CABG within 3 days related to better outcomes compared with that of surgery within 1-2 days. These findings provide evidence-based recommendations for optimizing CABG timing in AMI patients, consequentially reducing morbidity and mortality.
METHODS: We conducted a nationwide retrospective analysis of the National Health Insurance Service of Korea database, focusing on 1 705 843 adult AMI patients diagnosed between 2007 and 2018 who underwent CABG within 1 year of diagnosis. Patients were categorized based on CABG timing. Primary endpoints included cohort identification and the time interval from AMI diagnosis to CABG. Secondary endpoints encompassed major adverse cardiac and cerebrovascular events (MACCEs) and the impact of postoperative medications.
RESULTS: Of the patients, 20 172 underwent CABG. Surgery within 24 h of AMI diagnosis demonstrated the most favorable outcomes, reducing cardiac death, myocardial infarction recurrence, and target vessel revascularization. Delayed CABG within 3 days also outperformed surgery within 1-2 days post-AMI. Additionally, postoperative aspirin use was associated with improved MACCE outcomes.
CONCLUSIONS: CABG within 24 h of AMI diagnosis was associated with significantly minimized myocardial injury, emphasizing the critical role of rapid revascularization. Delayed CABG within 3 days related to better outcomes compared with that of surgery within 1-2 days. These findings provide evidence-based recommendations for optimizing CABG timing in AMI patients, consequentially reducing morbidity and mortality.
摘要：
背景：急性心肌梗死（AMI）是全球主要的健康问题。然而,AMI患者冠状动脉旁路移植术(CABG)的最佳时机仍存在争议.这项研究调查了CABG的最佳时机及其对术后结局的影响。我们假设确定CABG的最佳时机可以对术后结局产生积极影响。
方法：我们对韩国国民健康保险服务数据库进行了全国性的回顾性分析，重点调查了1705843例2007-2018年诊断的成人AMI患者,这些患者在诊断后1年内接受了CABG.根据CABG时机对患者进行分类。主要终点包括队列识别和从AMI诊断到CABG的时间间隔。次要终点包括主要不良心脑血管事件（MACCEs）和术后药物的影响。
结果：在患者中，20172例接受CABG。AMI诊断后24小时内的手术显示出最有利的结果，减少心脏死亡,心肌梗死复发，和目标血管血运重建。在AMI后1-2天内，3天内延迟的CABG也优于手术。此外,术后使用阿司匹林与改善MACCE结局相关.
结论：AMI诊断24h内CABG与显著降低的心肌损伤相关，强调快速血运重建的关键作用。与1-2天内手术相比，3天内延迟CABG与更好的结果相关。这些发现为优化AMI患者的CABG时机提供了循证建议。从而降低发病率和死亡率。
方法：我们对韩国国民健康保险服务数据库进行了全国性的回顾性分析，重点调查了1705843例2007-2018年诊断的成人AMI患者,这些患者在诊断后1年内接受了CABG.根据CABG时机对患者进行分类。主要终点包括队列识别和从AMI诊断到CABG的时间间隔。次要终点包括主要不良心脑血管事件（MACCEs）和术后药物的影响。
结果：在患者中，20172例接受CABG。AMI诊断后24小时内的手术显示出最有利的结果，减少心脏死亡,心肌梗死复发，和目标血管血运重建。在AMI后1-2天内，3天内延迟的CABG也优于手术。此外,术后使用阿司匹林与改善MACCE结局相关.
结论：AMI诊断24h内CABG与显著降低的心肌损伤相关，强调快速血运重建的关键作用。与1-2天内手术相比，3天内延迟CABG与更好的结果相关。这些发现为优化AMI患者的CABG时机提供了循证建议。从而降低发病率和死亡率。
