During acute phase of myocardial infarction (MI), the culprite artery must be revascularized quickly with angioplasty. Then, surgery complete the procedure in a second time. If surgery is emergent, resulting death rate is really high; 15 to 20% of patients operated on within the first 48hours and 4 to 5% for patients operated on after. Various factors influence mortality rate; timing of surgical revascularization and patient's preoperative state.

2007 to 2017 retrospective and monocentric study including 477patients after MI, hemodynamically stable who underwent urgent coronary bypass. Three groups were described, depending on surgery timing; during the first two days (n=32, 6.7%), between 3 and 10days (n=321, 67.3%) and after 11days (n=124, 26%). The primary end point was 30-day mortality.

The 3groups didn’t differ in their clinical characteristics. Mean Euroscore 2 was 3.0±4.1. Thirty-day mortality was 5.5% (n=26). Main causes of death were multi-organ failure (n=12, 46.1%), cardiorespiratory arrest or cardiogenic shock (n=9, 35%), mesenteric ischemia (n=2, 8%) and stroke (n=1, 4%). Death rate was significantly higher in group 1 (n=5; 15.6% vs. n=13; 4.0% vs. n=8; 6.4%, P=0.019). Mortality risk factors were age (OR 1.05; CI95%: 1.00–1.11; P=0.027), arteriopathy (OR 3.31; CI95%: 1.16–9.43; P=0.024) and preoperative ischemic recurrency (OR 4.88; CI95%: 2.12–11.3; P<0.001). Ninety-two patients presented preoperative ischemic recurrency (19%) with higher rate in groups 1 and 3 [14 (40%) vs. 48 (15%) vs. 30 (24%), P<0.001]. Recurrency rate was significantly higher in patients with unsuccessful angioplasty (7 vs. 15%, P=0.02.

Optimal timing for surgical revascularization of MI seems to be between 3 and 10days in stable patients. But, timing is not the only influencing factors in death rate, patient's health condition and disease severity must be considered in the individual management strategy.