Identification of candidates for coronary artery bypass grafting admitted with STEMI and Multivessel Disease

Cardiovasc Revasc Med. 2018 Sep;19(6S):21-26. doi: 10.1016/j.carrev.2018.06.007. Epub 2018 Jun 13.

Abstract

Background: The optimal management of patients with multivessel coronary artery disease (MVD) admitted with STEMI is under debate. CABG is rarely performed, even on ideal candidates. A provisional PCI without stent implantation may allow complete surgical revascularization (CSR) in a subset of patient that we sought to identify in this study.

Methods: Patients with STEMI from April 2014 to October 2016 were evaluated and those with a TIMI flow <3 in the culprit vessel, and an additional stenosis of >70% in an epicardial vessel or sidebranch >2.5 mm were selected. Epidemiological variables, surgical risk scores and SYNTAX and SYNTAX II scores were analyzed. All the selected patients were discussed in a post hoc heart-team, and predictors of 12-month events were also analyzed.

Results: Seventy-two (19.0%) accomplished MVD criteria. Mean SYNTAX was 19 ± 13 points and SYNTAX II score recommended CABG in 12 patients (16.7%) and heart-team discussion in 60 (83.3%). All patients were discussed in a post hoc heart-team, which concluded that 21 (29.2%) patients could have been good candidates for CSR. After one year follow-up, SYNTAX II PCI > 40 was found to be the sole independent predictor for 12-month events (OR 12.9 [2.7-62.1], p = 0.001).

Conclusions: MVD and STEMI with a SYNTAX II PCI > 40 should be discussed in an ad-hoc heart team, after a provisional revascularization of the culprit vessel, and should be considered for CSR, especially when the RCA is the culprit artery and there is a complex disease in the left coronary artery.

Keywords: CABG; Multivessel coronary artery disease; STEMI.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Clinical Decision-Making
  • Coronary Angiography
  • Coronary Artery Bypass* / adverse effects
  • Coronary Artery Bypass* / mortality
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / surgery*
  • Coronary Stenosis / diagnostic imaging
  • Coronary Stenosis / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Postoperative Complications / mortality
  • Predictive Value of Tests
  • Retrospective Studies
  • ST Elevation Myocardial Infarction / diagnostic imaging
  • ST Elevation Myocardial Infarction / mortality
  • ST Elevation Myocardial Infarction / surgery*
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome