Final answer:
For a STEMI, immediate CABG is often necessary, while for an NSTEMI, CABG is generally delayed after initial medical therapy including anti-platelet therapy. The decision is influenced by the clinical picture and urgency of the situation.
Step-by-step explanation:
The timing of Coronary Artery Bypass Grafting (CABG) for an ST-elevation myocardial infarction (STEMI) versus a non-ST-elevation myocardial infarction (NSTEMI) can vary based on the patient's condition and the urgency of the situation. For a STEMI, it is often the case that immediate revascularization is critical for preserving heart muscle, and immediate CABG might be recommended if percutaneous coronary intervention (PCI) is not available or feasible. However, for a NSTEMI, CABG is generally not performed immediately; the patient may be stabilized with anti-platelet therapy, such as dual therapy with clopidogrel and aspirin, and a more delayed CABG might be planned once the patient's condition has been assessed and managed with medical therapy.
In cases where a patient has had a stent placed, dual anti-platelet therapy should continue for a period of time, often at least 12 months, to reduce the risk of stent thrombosis, though this does not change the risk of death. The decision to proceed with CABG in the setting of acute myocardial infarction is tailored to each individual's clinical scenario, with factors like hemodynamic stability, ongoing chest pain, and the presence of complicating factors influencing the timing of surgery.