CABG in Patients With Acute MI

CABG in Patients With Acute MI:

Recommendations

CLASS I

1. Emergency CABG is recommended in patients with acute MI in
whom 1) primary PCI has failed or cannot be performed, 2) coronary
anatomy is suitable for CABG, and 3) persistent ischemia of a
significant area of myocardium at rest and/or hemodynamic instability
refractory to nonsurgical therapy is present. (Level of Evidence: B)

2. Emergency CABG is recommended in patients undergoing surgical
repair of a postinfarction mechanical complication of MI, such as
ventricular septal rupture, mitral valve insufficiency because of
papillary muscle infarction and/or rupture, or free wall rupture. (Level of Evidence: B)

3. Emergency CABG is recommended in patients with cardiogenic
shock and who are suitable for CABG irrespective of the time
interval from MI to onset of shock and time from MI to CABG. (Level of Evidence: B)

4. Emergency CABG is recommended in patients with life-threatening
ventricular arrhythmias (believed to be ischemic in origin) in the
presence of left main stenosis greater than or equal to 50% and/or
3-vessel CAD. (Level of Evidence: C)

CLASS IIa

1. The use of CABG is reasonable as a revascularization strategy in
patients with multivessel CAD with recurrent angina or MI within the
first 48 hours of STEMI presentation as an alternative to a more
delayed strategy. (Level of Evidence: B)

2. Early revascularization with PCI or CABG is reasonable for selected
patients greater than 75 years of age with ST-segment elevation or
left bundle branch block who are suitable for revascularization
irrespective of the time interval from MI to onset of shock. (Level of Evidence: B)

CLASS III: HARM

1. Emergency CABG should not be performed in patients with persistent
angina and a small area of viable myocardium who are stable
hemodynamically. (Level of Evidence: C)

2. Emergency CABG should not be performed in patients with noreflow
(successful epicardial reperfusion with unsuccessful microvascular
reperfusion). (Level of Evidence: C)

from 2011 ACCF/AHA CABG Guideline

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