Related Experiment Video
Updated: Jul 5, 2026
Surgical Swine Model of Chronic Cardiac Ischemia Treated by Off-Pump Coronary Artery Bypass Graft Surgery
Published on: March 27, 2018
Coronary artery bypass surgery in patients with acute coronary syndromes is difficult to predict
Derek P Chew1, Kenneth W Mahaffey, Harvey D White
1Flinders Medical Centre, Adelaide, Australia. derek.chew@flinders.edu.au
Insights
Predicting the need for coronary artery bypass grafting (CABG) in acute coronary syndrome (ACS) patients using initial data is challenging. Current models show poor ability to identify individuals requiring CABG, highlighting a gap in risk stratification for ACS management.
Area of Science:
- Cardiology
- Clinical Medicine
- Health Services Research
Background:
- Current guidelines recommend clopidogrel for acute coronary syndrome (ACS) patients unlikely to need coronary artery bypass grafting (CABG).
- A significant minority of ACS patients do require CABG, necessitating better prediction methods.
- The SYNERGY trial data was used to assess prediction of CABG need.
Purpose of the Study:
- To evaluate the ability of baseline demographics and clinical factors to predict the need for CABG in ACS patients.
- To assess the relationship between medication cessation timing, CABG timing, and clinical outcomes.
- To determine the discriminatory utility of predictive models for CABG need.
Main Methods:
- Analysis of 9053 patients undergoing angiography, identifying those who received CABG.
- Definition of early CABG as surgery within 72 hours of angiography.
- Assessment of demographic, clinical factors, and geographic location as predictors of early or any CABG, using logistic regression and c-index.
Main Results:
- 18.1% of patients (1793/9053) underwent CABG; 972 had early CABG.
- Early CABG was linked to increased bleeding events (39.2% vs 29.4%) but not death or myocardial infarction (MI).
- Predictive models demonstrated poor discriminatory ability (c-index 0.671) for identifying patients needing CABG.
Conclusions:
- Predicting which acute coronary syndrome patients require surgical revascularization based on initial clinical characteristics is difficult.
- The study highlights limitations in current risk stratification for CABG in ACS.
- Further research is needed to improve the identification of high-risk patients for CABG.
Background:
Although the use of clopidogrel in patients "unlikely" to require coronary artery bypass grafting (CABG) is recommended in current guidelines of acute coronary syndrome (ACS) management, an important minority of patients require CABG. We assessed the ability to predict need for CABG from demographics known at the time of ACS presentation, using data from SYNERGY.
Methods:
Patients undergoing CABG at any time after the index angiogram were included. Early CABG was defined as surgery <72 hours after angiography. The relationship between cessation of enoxaparin and glycoprotein IIb/IIIa inhibition, CABG timing, and 30-day death or MI and bleeding events was assessed. Demographic and clinical factors and geographic location were assessed as predictors of early CABG or CABG at any time. The discriminatory utility is reported with the c-index.
Results:
Of the 9053 patients undergoing angiography, 1793 (18.1%) received CABG. Early CABG (n = 972) was associated with more bleeding events (39.2% vs 29.4%, P < .001) but not death or MI. The risk of bleeding events diminished when surgery was delayed >18 hours after cessation of enoxaparin and glycoprotein IIb/IIIa inhibition. Clinical factors associated with early CABG included diabetes and lack of prior CABG or clopidogrel. However, overall the logistic regression model had poor discriminatory ability to predict patients likely to require CABG in the setting of an ACS presentation (c-index 0.671).
Conclusions:
It is difficult to predict those high-risk patients with ACS who will undergo surgical revascularization based on baseline clinical characteristics.
More Related Videos
05:25Surgical Porcine Model of Chronic Myocardial Ischemia Treated by Exosome-laden Collagen Patch and Off-pump Coronary Artery Bypass Graft
Published on: September 15, 2023
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery (ALCAPA)
Published on: April 24, 2017
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Acute Coronary Syndrome V: Nursing Management
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations