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Published on: November 24, 2014

Objective elaluation of bypass surgery in patients with acute coronary artery disease

J H Vogel, R B McFadden, D Cornish

    Advances in Cardiology
    |January 1, 1975
    PubMed

    Insights

    Coronary artery bypass surgery effectively treats acute coronary artery disease, improving ventricular function. Internal mammary artery grafts show superior patency for left coronary bypass compared to saphenous vein grafts.

    Area of Science:

    • Cardiology
    • Cardiac Surgery
    • Vascular Surgery

    Background:

    • Acute coronary artery disease (CAD) encompasses a spectrum of conditions including unstable angina and acute myocardial infarction.
    • Effective management of acute CAD is crucial for improving patient outcomes and reducing mortality.
    • Surgical revascularization is a key treatment modality for severe CAD.

    Purpose of the Study:

    • To evaluate the efficacy and outcomes of coronary artery bypass grafting (CABG) in patients with acute coronary artery disease.
    • To compare the patency rates of internal mammary artery (IMA) grafts versus saphenous vein (SV) grafts for left coronary artery bypass.
    • To assess the impact of CABG on ventricular function and long-term cardiac mortality.

    Main Methods:

    • Retrospective analysis of 80 patients with acute coronary artery disease undergoing bypass surgery.
    • Inclusion criteria: Patients with various acute CAD syndromes including post-infarction angina (PIA), acute myocardial infarction (AMI), and cardiogenic shock.
    • Assessment of surgical mortality, long-term cardiac mortality, ventricular function (ejection fraction, wall motion), and graft patency (IMA vs. SV).

    Main Results:

    • Surgical mortality rate was 1.4% in patients with PIA.
    • No cardiac deaths occurred during an average 15-month follow-up period.
    • Significant improvement in ventricular function (systolic ejection fraction, segmental wall motion) was observed in many patients.
    • Internal mammary artery grafts demonstrated 100% patency to the left anterior descending coronary artery, outperforming saphenous vein grafts for left coronary bypass.

    Conclusions:

    • Coronary artery bypass surgery is associated with low surgical mortality and excellent long-term survival in selected patients with acute coronary artery disease.
    • Internal mammary artery grafts are superior to saphenous vein grafts for left coronary bypass procedures due to higher patency rates.
    • Comprehensive evaluation including coronary and left ventricular cineangiography with hemodynamic assessment is recommended for patients presenting with acute coronary syndromes.
    • Myocardial revascularization via CABG may carry a lower risk than medical management for these high-risk patients.

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