Outcomes of Coronary Artery Bypass Grafting in Patients With ST-Elevation Myocardial Infarction and the Impact of Impella: A Retrospective Single-Center Study.

Objective:  ST-segment elevation myocardial infarction (STEMI) often requires urgent revascularization, with percutaneous coronary intervention (PCI) as the primary strategy. However, coronary artery bypass grafting (CABG) remains essential in cases where PCI is either unfeasible or fails. Emergency CABG for STEMI is associated with high operative risk and poor outcomes, especially in hemodynamically unstable patients. The Impella device (Abiomed Inc., Danvers, MA) provides percutaneous mechanical circulatory support (MCS), which stabilizes hemodynamics, enhances end-organ perfusion, and facilitates myocardial recovery through left ventricular unloading. These effects may allow for clinical stabilization before surgery, thereby reducing the need for emergency CABG and improving surgical outcomes. This study aimed to evaluate the outcomes of CABG for STEMI and to assess how the introduction of Impella influenced its indications, timing, and patient selection.

Methods:  We conducted a retrospective analysis of 59 consecutive patients with STEMI who underwent CABG between 2012 and 2023. Clinical data were obtained from the institutional electronic medical records for all patients included in this study. Patients were classified as requiring emergency, urgent, or elective procedures. Clinical and procedural data were compared before and after the introduction of Impella in 2019.

Results:  The hospital mortality occurred in one patient (1.7%), including one patient (3.3%) among emergent cases. Postoperative complications occurred in 13 patients (43.3%) of emergency cases, five patients (27.8%) of urgent cases, and none of the elective cases. Sepsis and acute kidney injury were the most common complications. The length of stay in the intensive care unit was significantly longer for emergent cases than for urgent and elective cases. CABG for STEMI was performed in 49 cases before the introduction of Impella and in 10 cases afterward. This led to a decrease in the rate of CABG performed for STEMI from 11.2% to 4.3%. Although the difference was not statistically significant, the proportion of emergency CABG decreased from 53.1% to 40%, while urgent CABG increased from 26.5% to 50%, suggesting a trend toward surgical stabilization. Regarding the use of MCS, the rate increased from 53.1% (26 patients) before Impella introduction to 70% (seven patients) after, with Impella used in 20% (two patients) of the latter group.

Conclusion:  CABG remains a viable option for patients with high-risk STEMI. Observations suggest that the use of Impella may be linked to a shift in CABG indications, from unsuitable PCI to failed PCI, and a tendency toward less emergent surgical timing.