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Surgical revascularization for acute coronary syndrome: comparative surgical and long-term results
Keiji Kamohara1, Masaru Yoshikai, Junji Yunoki
1Department of Cardiovascular Surgery, Tenjin-kai Shin-Koga Hospital, Kurume, Fukuoka, Japan.
Insights
Urgent coronary artery bypass grafting (CABG) is a safe option for acute coronary syndrome (ACS) patients, showing comparable long-term outcomes to emergency CABG. Stabilizing ACS patients with medical therapy before urgent CABG improves results.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Acute coronary syndrome (ACS) management often involves complex decisions regarding surgical intervention timing.
- Emergency coronary artery bypass grafting (CABG) has historically been associated with higher risks.
Purpose of the Study:
- To evaluate the optimal timing for CABG in patients presenting with ACS.
- To compare early and long-term outcomes between emergency and urgent CABG for ACS.
Main Methods:
- Retrospective analysis of 67 ACS patients undergoing CABG.
- Patients were divided into an emergency CABG group (E-G, n=33) and an urgent CABG group (U-G, n=34).
- Medical stabilization, including intra-aortic balloon pumping or percutaneous coronary intervention, was prioritized before urgent CABG.
Main Results:
- The emergency CABG group had higher preoperative incidences of acute myocardial infarction and cardiogenic shock.
- Hospital mortality was 9.1% in E-G versus 2.9% in U-G (no significant difference).
- Five-year survival and cardiac event-free rates were comparable between groups (approximately 80%).
Conclusions:
- Emergency CABG can be reserved for ACS patients whose condition is stabilized with medical therapy.
- High-quality, complete surgical revascularization is crucial for improving long-term outcomes in ACS patients undergoing CABG.
Objective:
The purpose of this study was to evaluate the adequate timing of coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS).
Methods:
In our institution, emergency CABG has been avoided when possible for ACS patients favoring stabilization with medical therapies, including intra-aortic balloon pumping or percutaneous coronary intervention. After thorough preoperative examinations, an urgent CABG is performed. A total of 67 patients with ACS underwent CABG, comprised of 33 patients receiving an emergency CABG (emergent group: E-G) and 34 patients receiving an urgent CABG (urgent group: U-G). The early and long-term results were evaluated retrospectively.
Results:
Preoperatively, the incidences of acute myocardial infarction and cardiogenic shock were significantly higher in E-G. No significant differences were found in the intraoperative factors except for the number of distal anastomoses (2.5 in E-G vs. 3.1 in U-G, p=0.01). The hospital mortality was 9.1% in E-G, and 2.9% in U-G, with no significant difference between the groups. Moreover, no patient in U-G necessitated emergency CABG while waiting for surgery. The patency rate of the grafts was 100% in E-G, and 96.2% in U-G. The 5-year survival rate excluding in-hospital death was 80.3% in E-G, and 78% in U-G (p>0.05). The 5-year cardiac event-free rate was 80.3% in E-G, and 80.9% in U-G (p>0.05).
Conclusion:
An emergency CABG can be reserved for ACS patients when symptoms and hemodynamic state are stabilized with medical therapies. Improvements in long-term results can be expected after high quality and complete surgical revascularization.
