Coronary artery bypass surgery in patients with acute MI



==ACCF/AHA Guidelines for CABG in Patients with Acute MI == {{cquote|

Class I
1. Emergency CABG is recommended in patients with acute MI in whom:
 * primary PCI has failed or cannot be performed,
 * coronary anatomy is suitable for CABG, and
 * 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)}}

Guidelines Resources

 * 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery : A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines