Recover of left ventricular function following immediate coronary artery bypass grafting in myocardial infarction

Objectives: The best time point for CABG following NSTEMI is controversially discussed. While keeping a time-lapse before revascularization for “cooling down” the infarction might improve perioperative safety, delayed revascularizations can hold the risk of prolonged ischemia leading to ventricular remodeling with loss of ventricular function. The aim of our study was to assess the outcome of patients receiving immediate CABG in the context of acute NSTEMI with special focus on the analysis of left ventricular function including regional wall motion patterns previous and after revascularization.

Methods: We analyzed the data of 20 consecutive patients with NSTEMI and 3-vessel disease that underwent eCABG in 2012 at our institution. 3D-Echocardiography (ie33 MATRIX, Philips Healthcare) was performed at admission and before discharge for assessment of left ventricular function and wall motion analysis. A semi-quantitative scale ranging from 0 (no change) to 5 (full recovery) categorized the changes of regional wall motion abnormalities.

Results: Demographics: 90% male, age 64,9 ± 9,7 y, 85% 3-vessel-CAD, 70% LMSS, 10% preoperative low cardiac output. Preoperative cardiac enzymes: CK 316 ± 609 U/l; CK-MB 37 ± 52 U/l. Maximum postoperative enzymes: CK 1038 ± 961 U/l; CK-MB 98 ± 108 U/l. LV-EF was 39 ± 10% at admission and 49 ± 8% following CABG surgery (p < 0,05). 65% of the patients showed a recovery of regional wall motion abnormalities (3,1 ± 1,1). Mean ICU stay was 4,0 ± 1,2 d. 30-day survival was 95%.

Conclusions: Our data show that eCABG can be performed in NSTEMI with low mortality and fast convalescence. Moreover we observed an important gain of LV function accompanied by a decline of wall motion abnormalities, which we associate to the recovery of stunned myocardium.