Alexey Dyachkov » Вт окт 25, 2011 5:21 pm
Pasha, privet.
Est' takoi istochnik. Ni slova pro 3 mesyaca.
ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary
Circulation. 2004; 110: 588-636
J. CABG Surgery After STEMI
1. Timing of Surgery
Class IIa
1. In patients who have had a STEMI, CABG mortality is elevated for the first 3 to 7 days after infarction, and the benefit of revascularization must be balanced against this increased risk. Patients who have been stabilized (no ongoing ischemia, hemodynamic compromise, or life-threatening arrhythmia) after STEMI and who have incurred a significant fall in LV function should have their surgery delayed to allow myocardial recovery to occur. If critical anatomy exists, revascularization should be undertaken during the index hospitalization. (Level of Evidence: B)
The Writing Committee believes that if stable STEMI patients with preserved LV function require surgical revascularization, then CABG can be undertaken within several days of the infarction without an increased risk.
2. Arterial Grafting
Class I
1. An internal mammary artery graft to a significantly stenosed left anterior descending coronary artery should be used whenever possible in patients undergoing CABG after STEMI. (Level of Evidence: B)
3. CABG for Recurrent Ischemia After STEMI
Class I
1. Urgent CABG is indicated if the coronary angiogram reveals anatomy that is unsuitable for PCI. (Level of Evidence: B)
4. Elective CABG Surgery After STEMI in Patients With Angina
Class I
1. CABG is recommended for patients with stable angina who have significant left main coronary artery stenosis. (Level of Evidence: A)
2. CABG is recommended for patients with stable angina who have left main equivalent disease: significant (at least 70%) stenosis of the proximal left anterior descending coronary artery and proximal left circumflex artery. (Level of Evidence: A)
3. CABG is recommended for patients with stable angina who have 3-vessel disease (Survival benefit is greater when LVEF is less than 0.50). (Level of Evidence: A)
4. CABG is beneficial for patients with stable angina who have 1- or 2-vessel coronary disease without significant proximal left anterior descending coronary artery stenosis but with a large area of viable myocardium and high-risk criteria on noninvasive testing. (Level of Evidence: B)
5. CABG is recommended in patients with stable angina who have 2-vessel disease with significant proximal left anterior descending coronary artery stenosis and either ejection fraction less than 0.50 or demonstrable ischemia on noninvasive testing. (Level of Evidence: A)