It should be considered emergency coronary artery bypass grafting (CABG) if a patient with a deteriorating acute myocardial infarction (AMI) cannot be stabilized with thrombolytic therapy, invasive cardiologic intervention, or both.

From June 1994 to March 1998, 65 consecutive patients underwent emergency CABG at our institution within first 6 hours of AMI. After cardiac catheterization surgical intervention was required when other therapeutic modality had been unsuccessful. Patients with ongoing ischemia, hemodynamic instability or both were considered as the canditates. The mean age was 63.2 ± 3.1, ranging from 24 to 83 years. 12 patients (18.5%) were female. In 48 patients (73.8%) anterior and in 17 (26.2%) inferior infarction was present. There were multivessel disease in 59 patients (90.7%) and main coronary lesion in 6 (9.2%). 11 patients (16.9%) had previous MI. Three patients (4.6%) with previous left ventricle aneurysm (Reinfarction) were admitted in cardiogenic shock and acute pulmonary edema. Seventeen patients (26.1) were in cardiac arrest before the angiography or on the way to the operating room.

The average reperfusion time was 4.2 ± 0.7 hours. The left internal mammary artery to the left anterior descending artery anastomosis were performed in 29 patients (44.6%). Mean graft per patient was 3.1. Three patients had aneurysmectomies. The inhospital mortality (30 days) was 6.1% (4 patients including 2 operative death). In mean 22 months of follow-up period all surviving patients were asymtomatic and doing well except NYHA class II in 5 patients.

We believe that emergent CABG in very early period of infarction is a life-saving procedure with an acceptable mortality. The complications of AMI may be prevented and restricted infarct size.

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