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[Surgical results of emergent coronary artery bypass grafting]
F Oguma1, S Kasuya, K Yamamoto
1Department of Cardiovascular Surgery, Tachikawa General Hospital, Nagaoka, Japan.
Insights
Emergent coronary artery bypass grafting (CABG) for unstable angina pectoris (UAP) and acute myocardial infarction (AMI) shows variable outcomes. Safe revascularization is possible for UAP and uncomplicated AMI, but outcomes for AMI with cardiogenic shock remain challenging.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Context:
- Emergent coronary artery bypass grafting (CABG) is a critical intervention for acute cardiac events.
- Over five years, 57 patients underwent emergent CABG for unstable angina pectoris (UAP) or acute myocardial infarction (AMI).
- Postoperative mortality was observed in 5 patients, with higher rates in the AMI group.
Purpose:
- To evaluate the outcomes of emergent coronary artery bypass grafting (CABG) in patients with unstable angina pectoris (UAP) and acute myocardial infarction (AMI).
- To assess the safety and efficacy of complete revascularization in these emergent settings.
- To identify factors influencing mortality in patients undergoing emergent CABG.
Summary:
- Emergent CABG was performed on 57 patients: 38 for UAP and 19 for AMI.
- Mortality rates were 5.3% for UAP and 15.8% for AMI.
- While complete revascularization is safe for UAP and uncomplicated AMI, outcomes for AMI with cardiogenic shock are discouraging, with 2 of 7 preoperative shock patients dying.
Impact:
- Complete revascularization is a safe and effective strategy for patients with UAP and uncomplicated AMI.
- The study highlights the need for careful consideration and potentially alternative strategies for AMI patients presenting with cardiogenic shock.
- Optimal timing for left main syndrome interventions should be guided by ischemia or necrosis presence.
Abstract:
During a period of past five years, 57 patients underwent emergent coronary artery bypass grafting at our hospital. The reason for performing emergent CABG were unstable angina pectoris in 38 patients and acute myocardial infarction in 19 patients. Five patients died postoperatively. Mortality rate was higher in the patients with AMI (15.8%) than in the patients with UAP (5.3%). Among 19 patients after AMI, 7 patients were in cardiogenic shock preoperatively, and two of them died after operation. Though the surgical results for AMI with cardio-genic shock is discouraging, complete revascularization can be performed safely for the patients with UAP and uncomplicated AMI. It appears that optimal timing of the patients with left main shock syndrome should be guided by the relative presence of an element of ischemia or necrosis.