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[Emergency coronary artery bypass grafting for acute coronary syndrome]
H Ohashi1, Y Tsutsumi, T Kawai
1Department of Surgery, Fukui Cardiovascular Center, Japan.
Insights
Emergency coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) showed high mortality, especially in shock patients. Improved myocardial preservation and mechanical support are crucial for reducing deaths.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Critical Care Medicine
Context:
- Acute coronary syndrome (ACS) management
- Emergency coronary artery bypass grafting (CABG) indications
- High-risk patient populations undergoing cardiac surgery
Purpose:
- To evaluate the outcomes of emergency CABG in patients with acute coronary syndrome (ACS).
- To identify factors associated with high operative mortality in this patient cohort.
- To determine the need for advanced myocardial preservation and mechanical support.
Summary:
- The study analyzed 146 patients undergoing emergency CABG for medically refractory unstable angina (UAP), acute myocardial infarction (AMI), and post-infarction angina (PIA).
- Mortality rates were 12% for UAP, 33% for AMI, and 13% for PIA. Extremely high mortality was observed in shock-state (48%) and cardiac arrest (85%) patients.
- Poor outcomes were linked to non-recanalized infarct-related arteries preoperatively.
Impact:
- Highlights the significant risks associated with emergency CABG in ACS, particularly in critically ill patients.
- Emphasizes the need for enhanced myocardial preservation techniques.
- Underscores the requirement for robust mechanical assist systems to manage postoperative myocardial failure.
Abstract:
Emergency CABG for acute coronary syndrome (ACS) was studied. Sixty patients had CABG for medically refractory UAP, 78 patients for AMI and 8 patients for post-infarction angina (PIA). In UAP group 7 patients (12%) died postoperatively, mainly due to perioperative myocardial infarction (PMI) and operative complications. In AMI group, 26 patients (33%) died, 14 of them due to myocardial failure. The operative mortality was extremely high in shock-state patients group (48%) and cardiac pulmonary arrest state patients group (85%). Operative result was poor in those patients whose infarct-related artery was not recanalized preoperatively. Operative mortality was 13% in PIA group. It was concluded that the reduction of mortality of those patients required much refined myocardial preservation technique and powerful mechanical assist system to support the postoperative myocardial failure.