Emergency Cabg In The Setting Of Stemi

Acute ST-elevation myocardial infarction (STEMI) continues to be a serious health condition all across the world. Despite many significant advances in the treatment of this problem, especially technological progress with percutaneous coronary interventions (PCI), a significant number of patients will still require emergency or urgent coronary artery bypass graft (CABG) surgery.According to the latest guidelines, urgent or emergency CABG surgery in STEMI should be considered :x Failed PCI with persistent pain or hemodynamic instability in patients with suitable anatomy for surgery (class I; level of evidence B)x Persistent or recurrent ischemia refractory to medical therapy in patients not candidates for PCI or lytic therapy with suitable anatomy (class I; B)Simultaneous with surgical repair of post-MI VSD or post-MI MR (class I; B)x Cardiogenic shock in patients < 75 y o within 36 hr of STEMI with severe multi-vessel or left main disease and suitable for revascularization that can be performed < 18 hr of shock (class I; A)x Life-threatening ventricular arrhythmias in the presence of 50% or more left main stenosis and / or 3VD (class I; B)Emergency surgery should not be performed in patients with persistent angina and a small area of myocardium at risk if they are hemodynamically stable or after successful PCI with persistent ischemia on the basis of microvascular obstruction (class III; C).