Early postoperative complications in patients with acute myocardial

infarction during emergency coronary bypassing

BORYS TODUROV1, ALEXANDER BITSADZE1

1SE “Heart Institute of MOH of Ukraine”, Kyiv, UKRAINE

Abstract: Despite the success results of interventional cardiology, the indications for coronary artery bypass grafting in acute

myocardial infarction, according to the recommendations, are quite limited. In recent years, the optimization of perioperative

management of patients, including myocardial protection, has helped to improve the effects of treatment by emergency surgical

revascularization in patients with cardiogenic shock. Thus, it is important to learn the results of emergency surgical myocardial

revascularization in patients with acute myocardial infarction (AMI), which were previously considered incurable or in cases

where interventional cardiology is ineffective. Therefore, the aim of the study was to conduct a prospective analysis of the

immediate clinical results of the early postoperative period to determine the factors of early mortality in emergency coronary

artery bypass grafting. Research methods. The research is based on the prospective investigation of 129 patients who were

hospitalized in Kyiv “Heart Center” through the period from 2011 to 2015. At 100,0% the ST-elevated myocardial infarction

(STEMI) of them it was verified, at 29,0 patients non- ST-elevated myocardial infarction (NSTEMI) was set. In early

postoperative period, we have analyzed such events like inotropic support duration, necessity of intra-aortic balloon pump, the

episodes of the development kidney injury and respiratory failure, complete atrioventricular blockade, supraventricular

tachyarrhythmia episodes, encephalopathy, rethoracotomy needs. Also early postoperative mortality endpoints were evaluated.

Research results. It has been proven that in the presence of STEMI type of acute myocardial injury compared with NSTEMI type,

there is a higher risk of acute left ventricular failure (p <0.05) followed by intra-aortic balloon pulsation (IABP)- procedure (p

<0,05) and inotropic support (p <0,05) in the early postoperative period. In patients of the STEMI group, acute kidney injury was

recorded more often with reliable indexes of absolute and relative risks (p <0,05). All cases of transient atrioventricular block

after emergency coronary artery bypass grafting (CABG) were registered in patients with STEMI injury with significant changes

of odds ratio (p <0.05). It was established that the main structure of respiratory complications was due to prolonged mechanical

ventilation, but the difference in the relative risk and odds ratio between the STEMI and NSTEMI groups is insignificant (p>

0.05), however the likelihood of supraventricular arrhythmia and encephalopathy in the NSTEMI group was reliably higher (p

<0.05). Estimates of the level of early postoperative mortality (12.4%) proved the probable relative risk (p <0.05) and the odds

ratio (p <0.05) of mortality in the STEMI group, which was confirmed by the analysis of cumulative survival by Kaplan-Meyer

method (Criterion log-rank 2,74; p = 0,006). Mortality in the STEMI group was associated with previously diagnosed acute heart

failure (56,2%), the onset of cardiogenic shock (31,3%) and the development of acute mitral regurgitation (12.5%). Conclusions.

STEMI type of acute myocardial damage installed reliably higher absolute and relative risk of acute left ventricle failure (p<0,05)

with following intra-aortic balloon pump (p<0,05), inotropic support (p<0,05) and acute kidney injury with glomerular rate

reduction (p<0,05) in the early postoperative period. The higher absolute and relative risks of encephalopathy, as well as the

possibility of supraventricular arrhythmia presented at NSTEMI patients (p<0,05). All cases of transient atrioventricular blockade

and early hospital mortality with reliable odds ratio, absolute and relative risks changes registered at STEMI patients (p<0,05).

Prospects for further research are long-term prospective observation, analysis of long-term clinical results of coronary artery

bypass grafting in patients with acute myocardial infarction, as well as assessment of risk factors for long-term mortality.

Keywords: complications, coronary artery bypass grafting, immediate surgical coronary revascularization, myocardial infarction,

NSTEMI, STEMI.

Received: May 28, 2022. Revised: August 11, 2022. Accepted: September 14, 2022. Published: October 10, 2022.

1. Introduction

CUTE myocardial infarction (AMI) is the most severe

complication of coronary artery disease, resulting in acute

or advanced heart failure and severe arrhythmias. Despite the

progress of medicamentous and interventional treatment of

patients with AMI, morbidity and mortality in this form of

coronary artery disease remain high [1], [2].

Undoubtedly, an invasive strategy for the treatment of AMI

is more effective than a non-invasive one. As a result, coronary

angiography is performed in a significant number of patients

with AMI, and, accordingly, the proportion of patients in

whom for one reason or another it is impossible to perform

stenting [3].

At present, the large amount of data obtained from

randomized trials confirms the advantage of early invasive

strategy over conservative, so in high-risk patients,

interventional intervention should be performed as early as

possible [4], which is confirmed in multicenter studies [5], [6].

That is, myocardial revascularization in patients with AMI is

the method of choice. At the same time, it is important to

develop criteria that can influence the decision making on the

choice of percutaneous coronary intervention (PCI) or

coronary artery bypass grafting (CABG) [7]. In recent years,

the optimization of perioperative management of patients,

including myocardial protection, has improved the effects of

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treatment of emergency surgical revascularization in patients

with cardiogenic shock [8]. That is, today emergency coronary

artery bypass grafting is no longer considered an intervention

of despair. Thus, it is important to study the results of

emergency surgical myocardial revascularization in patients

with AMI, which were previously considered incurable or in

cases where interventional cardiology is ineffective.

However, despite the success of interventional cardiology,

indications for coronary artery bypass grafting in acute

myocardial infarction, according to the recommendations, are

quite limited. The long-term prognosis for primary PCI and

external CABG is similar, but the average length of hospital

stay for PCI is shorter. In addition, a large number of modern

clinics do not always have the opportunity to accept a patient

urgently for surgery [9]. Therefore, it is necessary to develop

simple clear criteria for selecting patients with acute

myocardial infarction for emergency surgical

revascularization.

Thus, early postoperative complications are an actual

problem of cardiac surgery in patients with acute myocardial

infarction after emergency surgical revascularization.

The aim of this work is to conduct a prospective analysis of

the immediate clinical results of the early postoperative period,

to evaluate the factors of early mortality in emergency

coronary bypass grafting.

2. Material and Methods of Investigation

2.1 Material of Investigation

The work was performed in the departments of

endovascular surgery and angiography, clinical diagnostic

department, radiological diagnostics department, clinical

diagnostic laboratory of the Kyiv City Heart Center "Heart

Institute of the Ministry of Health of Ukraine" (Kyiv). The set

of clinical material was carried out during 2011-2015. The

research was based on the observation of 129 patients with

acute myocardial infarction (AMI). Of these, 100 patients were

diagnosed with acute ST-segment elevation myocardial

infarction (STEMI), and 29 were diagnosed as acute ST-

segment elevation myocardial infarction with ST-clinical

elevation). In all patients, the time from the onset of clinical

symptoms was less than 12 hours. The ratio of men and

women in the work was 87 (67,4%) to 42 (32,6%). The age of

patients ranged from 38,0 to 78,0 years, with an average of

62,0 ± 12,5. Criteria for inclusion of patients in the study were:

1) the presence of acute myocardial infarction with elevation

of the ST segment (STEMI); 2) acute myocardial infarction

without ST-segment elevation (NSTEMI); 3) carrying out

coronary ventriculography.

According to coronary angiography, in 129 patients

included in the study, in general 370 affected vessels were

detected - an average of 2,87 per patient. One-vascular lesion

was found in 2 cases (1,6%), two-vascular - in 13 cases

(10,1%), with the vast majority of patients with three-vascular

lesion - 114 people. (88,3%). At the same time, the lesion of

the trunk of the left coronary artery was found in 89 cases

(69,0%). Revascularization in all patients was performed up to

12,0 hours after the onset of myocardial infarction. Coronary

artery bypass grafting was performed using a noncardioplegic

technique with intermittent aortic compression and moderate

hypothermia (28,5 ± 0,5ºC). Each patient was fitted with 2,0 to

3,0 shunts. The average number of imposed shunts per patient

was 2,70 ± 0,4. The average duration of artificial circulation

was 61,0 ± 2,60 minutes.

The hospital observation period was 14,0-20,0 days, on

average 16,0 ± 2,80 days after emergency surgical

revascularization. During this period, the frequency of

intermediate and endpoints was assessed: the need for

inotropic support for more than 48 hours, the necessity for

intra-aortic balloon counter pulsation (IABP), kidney injury

and respiratory failure, the need for rethoracotomy, the

episodes of complete atrioventricular block, occurrence of

encephalopathy, nosocomial mortality, and supraventricular

tachycardia.

2.2 Methods of Investigation

The following research methods were used: clinical,

laboratory (blood biomarkers levels (C- and T- troponin,

myoglobin, MB-fraction of creatine phosphokinase)),

electrocardiography (ECG in 12 standard leads), advanced

electrocardiotopography (ECG in 60 leads), 24-hour (by

Holter) ECG monitoring, 3D-echocardiography and doppler

echocardiography, coronary angiography (CAG), shuntgraphy.

Diagnostic and control CAG, coronary ventriculography

(CVG) and coronary shuntography (CSHG) were performed

on an angiographic device AXIOM Artis FA by "Siemens"

(Germany), equipped with an electron-optical transducer with

image registration on a matrix 512 per inch in the international

medical format DICOM. Direct measurement of blood

pressure and ECG monitoring is performed using the AXIOM

Sensis Information System, which was part of the angiographic

complex. The evaluation of the results of coronary

angiography and coronary artery bypass grafting was

performed quantitatively with the help of angiographic

programs specially integrated into the computer system.

Calculations were performed in the end-diastolic phase (in the

absence of overlapping images of the branches of coronary

arteries) in orthogonal projection. All stenotic lesions of the

coronary arteries and shunts were analyzed for their

radiographic morphological features according to the

ACC/AHA classification.

2.3 Statistical Procedures

The obtained qualitative and quantitative clinical and

instrumental data were entered according to the protocol of the

investigation into a computer database. Statistical calculations

of the research data was performed using the program modules

of “Statistica 7.0” (Statsoft, USA).

In the biometric analysis of selected data used the following

methods and tools of mathematical statistics: Kolmogorov-

Smirnov criterion with Lilliefors correction and Shapiro-Wilk

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criterion; to compare quantitative values U Wilcoxon

homogeneity criterion and Mann-Whitney test were used. For

qualitative features, the χ² criterion with the Yates correction,

Fisher's exact F-test, were used. Comparison of quantitative

values in several unrelated groups was performed by analysis

of variance (ANOVA). The analysis of the probability of

outcomes in the investigation was performed by the Kaplan-

Meier method. Quantitative data are presented as M ± m

(where M is Mean, and m is standard deviation). At p <0,05

the results were considered statistically significant.

3. Results

Inotropic support for more than 48 hours in the

postoperative period was used in 79.8% of patients (103

people). At the same time, the additional risk of this endpoint

in patients with STEMI was 85.0%. Indicators of absolute risk

(AR,%), relative risk (RR) and odds ratio (OR) are presented

in Table 1.

Table 1. The need for inotropic support in patients with acute

infarction in the postoperative period, depending on the type

of myocardial injury

AR, %

ARR

STEMI

n=100

99,0

85,0

7,18

[2,89-17,9]

618,75

[66,4-5813,9]

NSTEMI

n=29

14,0

It also confirmed the position that the severity of myocardial

damage before surgical revascularization is a factor that

complicates the early activation of patients and increases the

duration of treatment in the intensive care unit, table 2.

Table 2. Peculiarities of the postoperative period in emergency

surgical revascularization depending on the type of myocardial

injury

STEMI

NSTEMI

Duration of inotropic

therapy, h.

68,9±16,4

52,3±8,4

<0,05

Duration of respiratory

support, h.

36,8±8,2

24,2±7,8

<0,05

Duration of treatment

in the intensive care

unit, h.

78,7±13,7

63,8±9,4

<0,05

Note: р - reliability of the difference in data between the

observation groups.

The need for intra-aortic balloon counter pulsation (IABP)

in patients with acute myocardial infarction during surgery

occurred in 27,1% of cases (35 patients out of 129). At the

same time, the absolute risk of left ventricular failure followed

by IABP procedure in the STEMI group was 32,0% versus

10,0% in the NSTEMI group, with risk reduction of 22,0% in

group 2. Relative risk indexes were also established (p < 0,05)

and odds ratios (p <0,05) of IABP in patients of the STEMI

group, table 3.

Table 3. Risk of left ventricular failure during emergency

surgical revascularization, depending on the type of

myocardial injury

AR, %

ARR

STEMI

n=100

32,0

22,0

3,09

[1,02-9,39]

4,08

[1,15-14,5]

NSTEMI

n=29

10,0

One of the most important steps in clinical research is the

choice of an endpoint that characterizes the disease and

objectively evaluates the effect of surgery. In the cumulative

analysis of the likelihood of acute left ventricular failure

(Kaplan-Meier method), the median of the event was

established after 6,69 days, with reliable indicators of the Log-

Rank test after 2,73 days (p = 0.006), Figure 1.

Acute kidney injury after emergency coronary bypass

grafting was registered in 5,4% of cases (7 people) among all

examined patients (129 people). All patients with a decrease in

glomerular filtration rate below 50.0 ml / min. were assigned

to the STEMI group in the preoperative period.

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Cumulative Proportion Surviving (Kaplan-Meier) of AHF

Complete Censored

STEMI

NSTEMI

0 5 10 15 20 25 30 35 40

Time

-0,2

0,0

0,2

0,4

0,6

0,8

1,0

Cumulative Proportion Surviving

Fig. 1. Cumulative analysis of the likelihood of acute left ventricular failure in patients with acute infarction after surgical revascularization

The additional risk of acute kidney injury after emergency

surgical revascularization corresponded to the absolute risk

and severity of myocardial injury (7.0%), with significant

evidence of the relative risk (p <0,05) and odds ratio (p

<0,05), table 4.

Table 4. The risk of acute kidney injury in the postoperative

period depending on the type of myocardial injury

AR, %

STEMI

n=100

7,0

203,07

[6,13-677,3]

218,28

[6,53-734,6]

NSTEMI

n=29

0,0

The frequency of respiratory failure in the early

postoperative period was set at 7.0% (9 patients), table 5.

Table 5. The risk of respiratory failure in the postoperative

period depending on the type of myocardial injury

AR, %

ARR

STEMI

n=100

8,0

5,0

2,32

[0,30-17,8]

2,43

[0,29-20,4]

NSTEMI

n=29

3,0

Prolonged mechanical ventilation occupied the main place

in the structure of respiratory complications among the

examined patients. At the same time, the absolute risk of

respiratory failure after surgical revascularization in patients

with acute myocardial infarction on the background of ST

segment elevation was set at 8,0% versus 3,0% in the absence

of ST segment elevation and absolute risk reduction was set at

5,0%

There were also established significant changes of the

relative risk (p <0,05) and the odds ratio (p <0,05) of

respiratory complications in the presence of acute myocardial

injury of the STEMI type, table 5.

At the same time, the absolute risk of rethoracotomy after

coronary artery bypass grafting was 3,0% (STEMI) and 3,4%

(NSTEMI). It was noted that the type of acute myocardial

injury was not a determining factor for this complication, and

the relative risk and odds ratio were unreliable (p> 0,05),

table 6.

Table 6. Rethoracotomy in the postoperative period depending

on the type of myocardial injury

AR, %

STEMI

n=100

3,0

0,87

[0,09-8,06]

0,87

[0,09-8,67]

NSTEMI

n=29

3,4

The absolute risk of encephalopathy in patients with

NSTEMI is set at 10,3%, and in the STEMI group – 6,0%, the

relative risk is 0,58 [0,15-2,18], the odds ratio is 0,55 [0,13-

2,37], table 7.

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Table 7. The risk of encephalopathy in the postoperative

period depending on the type of myocardial injury

AR, %

STEMI

n=100

6,0

0,58

[0,15-2,18]

0,55

[0,13-2,37]

NSTEMI

n=29

10,3

The absolute risk of transient atrioventricular (AV) block in

patients with STEMI type of myocardial injury was 4,0%

versus 0,0% in patients with NSTEMI type of acute infarction,

with significant relative risk (p <0,05) and odds ratio (p

<0,05), table 8.

Table 8. The risk of transient AV block in the early

postoperative period depending on the type of myocardial

injury

AR, %

ARR

STEMI

n=100

4,0

116,0

[3,46-391,0]

120,8

[3,58-410,8]

NSTEMI

n=29

0,0

The absolute risk of supraventricular tachcardia in the

STEMI group was 9,0%, while in NSTEMI patients – 21,0;

relative risk – 0,44 [0,17-1.12], odds ratio – 0,38 [0,12-1,17],

table 9.

Table 9. The risk of supraventricular tachicardia in the early

postoperative period depending on the type of myocardial

injury

AR, %

STEMI

n=100

9,0

0,44

[0,17-1,12]

0,38

[0,12-1,17]

NSTEMI

n=29

21,0

Postoperative mortality in patients with acute myocardial

infarction was 12.4% (16 clinical cases), Figure 2.

Yes

12,4

88,6

Postoperative

mortality

Fig. 2. Mortality in the early postoperative period in patients

with acute myocardial infarction after surgical

revascularization

Cumulative Proportion Surviving (Kaplan-Meier)

Complete Censored

STEMI

NSTEMI

0 5 10 15 20 25 30

Time

-0,2

0,0

0,2

0,4

0,6

0,8

1,0

Cumulative Proportion Surviving

Fig. 3. Cumulative analysis of survival according to Kaplan-Meier in patients with acute myocardial infarction in the early

postoperative period

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At the same time, according to the cumulative analysis of

Kaplan-Meier survival, all cases of postoperative mortality

were registered in patients who had myocardial infarction with

ST segment elevation with significant Log-rank test (2,74; p =

0,006), Figure 3.

The absolute risk of mortality in the STEMI group was

16,0% with identical ARR, significant relative risk (p <0,05)

and odds ratio (p <0,05), table 10.

Table 10. Absolute and relative risks, odds ratio of

postoperative mortality depending on the type of myocardial

injury

AR, %

ARR

STEMI

n=100

16,0

464,16

[1,41-536,9]

552,38

[1,67-845,6]

NSTEMI

n=29

0,0

The ratio of acute mitral regurgitation (followed by mitral

valve replacement) and early postoperative mortality was also

reliable: Pearson's χ2 – 12,76 (p = 0,003), conjugation

coefficient η – 0,336 (p <0,001), table 11.

Table 11. Acute mitral regurgitation, relative risk and odds

ratio of cardiogenic shock in patients with myocardial

infarction and ST segment elevation

ОR

Indexes

2,408

[1,853-3,963]

11,11

[2,35-52,59]

The relative risk and odds ratio of early mortality were

reliable (p <0,05), as evidenced by the confidence interval.

4. Discussion

However, our study identified a high absolute risk and a

probable relative risk of the need for inotropic support in the

postoperative period in the presence of STEMI, as well as the

occurrence of left ventricular failure followed by IABP

procedure. The risk of left ventricular failure was confirmed

by the Kaplan-Meier method by log-rank criterion. Acute

kidney injury with decreased glomerular filtration rate has

been reported in patients in the STEMI group, with higher

absolute and relative risk, and odds ratio. Similar results were

obtained in Dieberg G et al., who proved that the type of

myocardial damage is an important prognostic factor in early

postoperative mortality - in patients with viable myocardium

who underwent myocardial revascularization. In this case,

there were significantly lower rates of serious cardiovascular

complications, re-hospitalizations, progression of chronic heart

failure, compared with patients who did not perform

revascularization of a viable myocardium [10].

In our own study, the assessment of the hard (inflexible)

endpoint (hospital mortality) confirmed the presence of a high

absolute risk of mortality in the STEMI group, with probable

odds ratio, relative risk and level of cumulative survival

according to the analysis of Kaplan-Meyer. During the 1st day

2 deaths were registered, between 2-5 days - 8 deaths, for the

period of 6-14 days the mortality rate was 6,0%, the total

hospital mortality rate was 16,0%. No episodes of death were

reported after the 14th day of hospital stay. Mortality had a

close link to acute heart failure, cardiogenic shock and acute

mitral regurgitation. A prospective analysis of mortality by

cause was also performed, which, in summary, allows to

determine the important role of the severity of myocardial

damage as a prognostic factor during the postoperative period.

A study by Pieri M. et al., which included 7,313 patients

with acute coronary syndrome, showed about significantly

higher level of cardiac mortality in the optimal drug therapy

group than in patients who underwent surgical myocardial

revascularization. That is, the authors insist on the possibility

of emergency surgical myocardial revascularization in the

presence of acute myocardial infarction, and survival,

according to these authors depends on the initial value of

ejection fraction of left ventricle [11].

In another study, Koerich C. et al., in evaluating the

treatment outcomes of patients with severe coronary artery

disease and left ventricular systolic dysfunction who

underwent CABG, showed that in patients who were assessed

for myocardial viability, the postoperative survival rate was

significantly higher compared to with patients in whom only

coronary angiograms were analyzed before surgery and

amounted to 97,0 and 79,0%, respectively (p <0,05). The

authors also emphasize that in the first hours and days after

surgery, in the group with a viable myocardium, smaller

amounts of catecholamine support were required [12].

The analysis of the direct results of emergency surgical

revascularization in patients with acute myocardial infarction

revealed that the predominant position in the structure of

respiratory complications among the examined patients was

prolonged mechanical ventilation (7,0%), high absolute

(79.8%) and probable relative (p<0.05) risk of need for

inotropic support in the postoperative period, high level

(32,0%) and probable odds (p <0.05) of development of left

ventricular failure followed by intra-aortic balloon counter

pulsation (27,1%; p <0,05), significant relative risk and odds

of developing acute kidney injury (p <0,05), transient

atrioventricular block (p <0,05) in the presence of STEMI.

In the work of Rudenko A.V. and Zhurba O.O. an analysis

of the results of coronary artery bypass grafting of patients

treated at the National Institute of Cardiovascular Surgery

named after M.M. Amosov in the period from 2009 to 2013

was done. In this study, unfavorable factors of intraoperative

and postoperative complications recognized unstable

hemodynamics, intraoperative arrhythmias, intraoperative

bleeding and ECG changes during surgery, mortality in

isolated coronary artery bypass surgery in 2013 was 0.4%

[13], [14].

In our study, patients with acute myocardial infarction type

NSTEMI verified a higher absolute (10,3%), probable relative

risk and chances of acute encephalopathy (p <0,05), a greater

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number of clinical cases of supraventricular tachycardia

(20,7%, p <0.05).

Estimation of the level of early postoperative mortality

(12,4%) proved the probable relative risk (p <0.05) and the

odds ratio (p <0.05) of mortality in the STEMI group, which

was confirmed by the analysis of cumulative survival by

Kaplan-Meyer method (criterion) log-rank 2,74; p = 0,006).

Mortality in the STEMI group was associated with previously

diagnosed acute heart failure (56,2%), the onset of cardiogenic

shock (31,3%) and the development of acute mitral

regurgitation (12,5%).

According to the American Association of Cardiothoracic

Surgeons, mortality from coronary artery bypass grafting

depends on the surgical technique and is, in the analysis of a

number of studies, 1,4% without artificial circulation and 2,3%

with artificial circulation in men, 1,7% and 3,6% accordingly,

in women The authors also indicate that coronary artery

bypass graft surgery on a working heart can be a safe method

of performing interventions for almost all categories of

patients in need of surgical correction of coronary artery

disease, and can be used in 97.0% of cases [15].

Our results differ from those presented by Pidgain L. V. et

al. relative to the prognostic value of acute mitral regurgitation

of ischemic origin. All patients underwent coronary artery

bypass graft surgery and mitral valve plastic surgery with a

ring or sutures. The authors indicate that the course of the

early postoperative period was uncomplicated, there were no

cases of sudden death [16]. Foreign studies also indicate that

the addition of mitral valve plastics to coronary artery bypass

graft surgery in patients with moderate ischemic mitral

regurgitation may improve cardiac function, reverse left

ventricular remodeling, and reduce mitral regurgitation [17],

[18].

5. Conclusions

In this prospective study, the effectiveness of emergency

surgical revascularization in patients with acute myocardial

infarction was evaluated, the results of the early postoperative

period were analyzed and the factors of early mortality were

determined.

1. The analysis of the direct results of emergency surgical

revascularization in patients with acute myocardial infarction

revealed that the predominant place in the structure of

respiratory complications among the examined patients was

prolonged mechanical ventilation (7,0%), high absolute

(79,8%) and reliable relative(p <0,05) risk of need for

inotropic support in the postoperative period, high level

(32,0%) and odds ratio (p <0.05) of development of left

ventricular failure followed by intra-aortic balloon counter

pulsation (27,1%, p <0, 05), significant relative risk and odds

of developing acute kidney injury (p <0,05), and transient

atrioventricular block (p <0,05) in the presence of STEMI.

2. Patients with acute myocardial infarction with NSTEMI

type verified higher absolute (10.3%), probable relative risk

and odds of acute encephalopathy (p <0,05), higher percentage

of clinical cases with supraventricular tachycardia (20,7%, p <

0,05).

3. It has been proven that all cases of transient

atrioventricular blockade were registered in patients who had

previous acute myocardial infarction with ST segment

elevation in the preoperative period, significant odds ratio,

absolute and relative risks (p <0,05).

4. It was found that the main structure of respiratory

complications among the examined patients was due to

prolonged mechanical ventilation, but the difference between

the groups in terms of STEMI and NSTEMI odds ratio and

relative risk was insignificant (p> 0,05).

5. Estimation of the level of early postoperative mortality

(12,4%) showed a significant increase in the probable relative

risk (p <0,05) and odds (p <0,05) in the STEMI group, which

was confirmed by the analysis of cumulative survival by the

Kaplan-Meier method (log-rank criterion – 2,74, p = 0,006).

Mortality in the STEMI group was associated with previously

diagnosed acute heart failure (56.2%), the onset of cardiogenic

shock (31.3%) and the development of acute mitral

regurgitation (12.5%).

6. In the postoperative period of emergency surgical

revascularization during acute infarction, risk factors should be

carefully assessed to predict early postoperative mortality -

changes in left ventricular systolic dysfunction, the

development of kidney injury, the presence of pulmonary

hypertension, onset of atrioventricular block during

intervention.

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