Background: The time-point of acute coronary artery bypass surgery (CABG) in patients with acute myocardial infarction (AMI) remains a matter of debate. As bypass graft preparation may influence procedure time, acute CABG In AMI patients may result in inferior graft selection with reduced longevity.

Methods: we retrospectively analysed graft selection in 1427 AMI patients that underwent CABG within 48 hours after being diagnosed with AMI. Patient characteristics, intra- and post-operative parameters were compared between different patient groups based on graft selection. Short- and long-term survival as well as risk factors for mortality  were investigated.

Results: Among the 1427 AMI patients, 76.9% (1098) received a graft combination of the left internal mammary artery and the saphenous vein (L+VG), 7.4%(105) patients underwent total  arterial revascularization (TAR) and 9.9% (142) received only venous grafts(VG).  TAR patients were significantly younger (60.9 ± 12.4 vs 67.3 ± 9.7 and 67.83 ± 9.7years;p<0.001) and had a significantly lower EuroScore II (5.13 ± 5.1 vs 6.18 ± 11.0 vs 7.9 ± 7.8;p<0.001)compared to the other groups. On the other hand, VG patients were high-risk patients. 40% VG patients vs 4.7% of TAR and 9.3% of L+VG patients had undergone cardio-pulmonary resuscitation prior to CABG and 60% were in cardiogenic shock before surgery compared to 5.7% of TAR patients and 13.4% of patients with L+VG. 

Procedure time was significantly shorter in VG patients compared to the other groups (206.5(166-262) vs 231 (195-283) vs 220 (190-254)min; p<0.05). 

Post-operatively, more VG patients had to undergo a re-thoratomy (13.2% vs 7.6% vs 3.6%;p<0.001) and renal replacement therapy (31.1% vs 6.8% vs 11.2%;p<0.05). Stroke rates did not differ.

30-day mortality as well as 20-year survival rates were significantly lower in VG patients (p<0.01).

Summary and conclusion: Our data show that graft selection in AMI patients undergoing CABG was influenced by the clinical condition as well as the age of the respective patients. While selection of only venous grafts resulted in shorter procedure times, VG patients still suffered from a reduced short-term survival. Furthermore, long-term survival covering an observation period of 20-years was also significantly lower in this patient group.