Cardiac Surgery Clinical Trial
Official title:
Optimal Timing of Coronary Artery Bypass Grafting in Hemodynamically Stable Patient After Myocardial Infarction and Definition of Poor Prognostic Factors. Pilot Study
Acute coronary syndromes (ACS) represent the leading cause of death in France. Their
incidence is increasing due to population aging and to the persistence of cardiovascular risk
factors. Currently, revascularization surgery remains outside the emergency treatment,
because early performed, it tends to lead to extension and hemorrhage of the infarcted area,
because of the CPB, aortic clamping, cardioplegia, and other heart manipulation.
However, CABG are indicated as an emergency in some situations of STEMI: Threat of infarction
of an extended territory without favorable anatomy to angioplasty, anatomy not favorable to
angioplasty associated with cardiogenic shock or persistent ischemia, acute complications of
myocardial infarction (massive mitral insufficiency, interventricular communication, parietal
rupture) requiring surgery under CPB with concomitant bypass surgery or failure of
angioplasty (proximal coronary dissection).
Operative mortality is high; 15 to 20% for patients operated 12 to 48 hours after AMI and
4-5% for those operated after 48 hours.
Nevertheless, it seems legitimate to study if there would be a place for primary surgical
revascularization in case of patient with hemodynamically stable ACS, in order to limit
myocardial ischemia, spread of necrosis, to limit the risk of recurrence, and the
consequences of low cardiac output. Performing a complete early surgical revascularization
could limit the ischemia-reperfusion syndrome and anticipate the occurrence of cardiogenic
shock.
Trial on medical records only ;
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