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[Emergency coronary artery bypass grafting for ischemic heart disease]
1Department of Thoracic and Cardiovascular Surgery, Hyogo College of Medicine, Japan.
Insights
Emergency coronary artery bypass grafting (CABG) shows higher mortality, especially in elderly patients with acute myocardial infarction (AMI). Careful diagnosis and prompt treatment are crucial for improving outcomes in emergency CABG patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Emergency Cardiac Procedures
Context:
- A 10-year retrospective study (1988-1998) analyzed 74 patients undergoing emergency isolated coronary artery bypass grafting (CABG) with cardiopulmonary bypass.
- Emergency CABG was performed for unstable angina (UAP) in 52 patients and acute myocardial infarction (AMI) in 22 patients.
Purpose:
- To evaluate the outcomes of emergency coronary artery bypass grafting (CABG).
- To identify risk factors and propose strategies for improving operative results in emergency CABG, particularly in elderly populations.
Summary:
- The hospital mortality rate for emergency CABG was 19%, significantly higher than the 2.4% for scheduled CABG (p < 0.0001).
- Mortality was substantially higher in the AMI group (41%) compared to the UAP group (9.6%) (p < 0.005).
- Elderly patients (≥75 years) constituted 19% of emergency CABG cases, compared to 8.9% of scheduled cases (p < 0.05).
Impact:
- Findings highlight the critical need to reduce emergency CABG in the elderly through timely diagnosis and aggressive surgical intervention.
- Implementing strategies to optimize care for elderly patients undergoing emergency CABG can potentially improve overall surgical results and reduce mortality.
Abstract:
Between June, 1988 and May 1998, 524 patients underwent isolated coronary artery bypass grafting (CABG) utilizing cardiopulmonary bypass in our institution. The 74 patients who underwent CABG on emergency surgery were subjected in this study. Age was ranged 33 to 89 years (mean 65 +/- 1.1; 50 male, 24 female). Of 74 cases, 52 cases underwent emergency CABG due to UAP, and 22 cases were AMI. The hospital mortality rate in 74 cases was 19% (15/74) and 2.4% (11/450) in patients who had scheduled CABG (p < 0.0001). Mortality rate in AMI group was 41% (9/22) and 9.6% (5/52) in UAP (p < 0.005). Number of patients aged 75 years or elder was 14 (19%) in emergency CABG, and 43 (8.9%) in scheduled CABG (p < 0.05). To improve the operative results of emergency CABG, it is important to reduce the number of emergency CABG in elderly, by the careful diagnosis and aggressive surgical treatment as same as in younger patient.