Emergency myocardial revascularization for acute myocardial infarction: survival benefits of avoiding cardiopulmonary bypass

Objective: Emergency coronary artery bypass grafting (CABG) for acute myocardial infarction (AMI) is associated with increased operative mortality. It has been suggested that this mortality might be reduced by performing the operation without cardiopulmonary bypass (CPB). Methods: Between January 1992 and April 1998, 77 patients underwent emergency CABG within 48 h of AMI. Thirty seven were operated on with CPB, and 40 without CPB. The two groups were similar regarding age, gender, left-ventricular ejection fraction (EF) and preoperative use of intra-aortic balloon pump (IABP; 50%). The mean number of grafts/patient was 3 in the CPB group, and 1.9 in the NoCPB group (P < 0.0001). Results: Operative mortality in the CPB group was 24% (nine of 37) compared to 5% (two of 40) without CPB (P = 0.015). Follow-up ranged between 6 and 66 months. There were no late deaths in the CPB group compared to nine (22%) in the NoCPB group (P < 0.0066). Patients operated on with CPB had lower rates of recurrent angina (0 versus 15%; P = 0.04) and re-interventions (0 versus 15%; P = 0.04). Conclusions: Our experience suggests that CABG without CPB is the preferred method of myocardial revascularization, due to the fact that it carries lower mortality than CABG with CPB. The trade-off includes increased rates of recurrent angina, re-interventions and late mortality.