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True emergency coronary artery bypass surgery.
F H Edwards1, R F Bellamy, J R Burge
1Department of Cardiothoracic Surgery, Walter Reed Army Medical Center, Washington, DC 20307-5001.
The Annals of Thoracic Surgery
|April 1, 1990
Summary
True emergency coronary artery bypass grafting (CABG) for acute ischemia has a 14.5% mortality rate. Key risk factors include previous myocardial infarction and hypertension, with lower mortality when performed directly from catheterization.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Critical Care Medicine
Background:
- Previous emergency coronary artery bypass grafting (CABG) reports included non-emergent cases, skewing results.
- Accurate assessment of truly emergent CABG outcomes is crucial for patient care.
Purpose of the Study:
- To analyze outcomes and identify risk factors for truly emergent coronary artery bypass grafting.
- To differentiate outcomes based on the origin of the emergency (catheterization suite vs. ward/ICU).
Main Methods:
- Retrospective analysis of 117 patients undergoing true emergency CABG between January 1984 and January 1989.
- Inclusion criteria: acute refractory coronary artery ischemia requiring immediate surgery.
- Statistical analysis including univariate and stepwise multivariate analysis to identify mortality predictors.
Main Results:
- Overall in-hospital operative mortality was 14.5% (17/117), with 76.5% of deaths being cardiac-related.
- Major morbidity occurred in 35.9% of patients.
- Significant independent risk factors for mortality included previous myocardial infarction, hypertension, cardiopulmonary resuscitation, and reoperation.
- Mortality was significantly lower (4%) for patients directly from catheterization compared to those from the ward/ICU (22.4%).
Conclusions:
- True emergency CABG carries a substantial operative mortality and morbidity.
- Identifying specific risk factors allows for better patient selection and risk stratification.
- Urgent transfer to the operating room from the catheterization suite is associated with improved survival outcomes.