Abstract 3244: The Role Of Multiple Arterial Grafting In The Setting Of Acute Myocardial Infarction
OBJECTIVE: Early patency studies suggest that vein grafts are more likely to occlude in the perioperative period than arterial conduits. Graft patency is highly relevant in the setting of recent acute myocardial infarction(MI) where myocardial blood flow has been acutely compromised. We examined results of multiple arterial grafting in the setting of MI.
METHODS: CABG with LIMA+veins was performed in 1211 patients within 30 days of MI including 177 cases within 5 days of MI. Multiple arterial grafting( LIMA + Radial Artery or RIMA) was performed in 493 patients within 30 days of MI and 64 patients within 5 days of MI. Perioperative outcomes were compared using univariate, logistic regression and propensity matched comparisons.
RESULTS: Operative(30 day) mortality was 2.0% in patients receiving LIMA+ veins and 1.6% for multiple arterial grafting, unadjusted p=0.7. The composite endpoint of major adverse cardiac events(MACE) including death, perioperative MI or low output cardiac failure occurred in 20% of LIMA+ veins patients and 11.9% of multiple arterial grafting patients, unadjusted p= 0.003. Predictors of the MACE determined by logistic regression included longer pump-time, advanced age, renal dysfunction, reoperation, ejection fraction<35%, and peripheral vascular disease. Multiple arterial grafting was protective (OR 0.7, 95%CI 0.5– 0.96). Using propensity-matching, 388 LIMA+veins patients were matched to 388 multiple arterial grafting patients using 22 preoperative variables including disease severity and interval between MI and CABG surgery. Operative mortality occurred in 1.8% of LIMA+veins patients and 1.8% of multiple arterial grafting patients, p=0.9. MACE occurred in 17.8% of LIMA+veins patients and 11.6 % of multiple arterial grafting patients, p=0.03. Among patients who had surgery within 5 days of MI, there was no difference in MACE 24%(LIMA+veins) versus 21%(multiple arterial grafting), p=0.8. However, those who had surgery 5–30 days after MI had significantly less occurrence of MACE if multiple arterial grafting was employed(10.3%) versus LIMA+veins(16.4%), p=0.03.
CONCLUSIONS: Multiple arterial grafting is safe and reduces major adverse cardiac events in the perioperative period after acute myocardial infarction.