Role of coronary artery bypass grafting during the acute and subacute phase of ST-elevation myocardial infarction

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To optimise the treatment of patients with ST-elevation myocardial infarction (STEMI), timely reperfusion of the occluded coronary artery is essential.1,2 A reperfusion strategy consisting of primary percutaneous coronary intervention (PCI) has improved short- and long-term outcome in patients with STEMI and is now the preferred treatment modality.3,4 However, coronary angiography also identifies patients eligible for coronary artery bypass grafting (CABG) during the acute and subacute phase of STEMI.5,6 In some patients with a coronary anatomy unsuitable for PCI, CABG is used as the primary reperfusion modality either in the acute phase or after initial stabilisation. In most patients, CABG is performed after PCI as definitive or adjunctive revascularisation. A decade ago, Stone et al.7 reported that 11% of STEMI patients require CABG during hospital admission, and that these patients have a similar outcome to STEMI patients not requiring surgery. In the meantime, various advancements have been made in the interventional and surgical management of STEMI patients. In the contemporary interventional approach of STEMI patients, the majority of patients are treated with stenting and modern adjunctive antiplatelet therapies including glycoprotein (GP) IIb/IIIa inhibitors and clopidogrel. These developments may have an impact on the clinical management and outcome of contemporary STEMI patients. To place these recent advancements in perspective, we investigated the incidence and clinical outcome of CABG performed within 30 days in a contemporary cohort of patients presenting with STEMI. …