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Optimal coronary artery bypass grafting strategy for acute coronary syndrome

Hiroyuki Nishi1, Taichi Sakaguchi, Shigeru Miyagawa

  • 1Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan.

General Thoracic and Cardiovascular Surgery
|December 21, 2013
PubMed

Insights

Off-pump coronary artery bypass grafting (CABG) may benefit unstable angina patients, while on-pump beating CABG is suggested for acute myocardial infarction patients to reduce complications.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery Outcomes
  • Acute Coronary Syndromes

Background:

  • Conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass is linked to higher risks in acute coronary syndrome (ACS) patients.
  • Off-pump CABG (OPCAB) and on-pump beating CABG are alternative strategies with unknown efficacy in ACS.
  • This study investigates the comparative effectiveness of OPCAB and on-pump beating CABG for ACS patients.

Purpose of the Study:

  • To evaluate the outcomes of OPCAB and on-pump beating CABG in patients with acute coronary syndrome (ACS).
  • To compare perioperative status between unstable angina (UA) and acute myocardial infarction (AMI) patients undergoing CABG.
  • To determine the role of intra-aortic balloon pumping (IABP) in OPCAB for ACS.

Main Methods:

  • A retrospective analysis of 121 consecutive ACS patients undergoing CABG was performed.
  • Patients were categorized into unstable angina (UA) and acute myocardial infarction (AMI) groups.
  • Surgical strategies included off-pump CABG (OPCAB), on-pump beating CABG, and conventional CABG, with perioperative outcomes assessed.

Main Results:

  • For UA patients, OPCAB was the predominant strategy (87%), with low in-hospital mortality (1.3%). Preoperative intra-aortic balloon pumping (IABP) was associated with successful OPCAB completion.
  • In AMI patients, hospital mortality was higher (8.9%), with on-pump beating CABG being the most frequent approach (57%).
  • Mortality in AMI patients occurred exclusively in ST-elevation myocardial infarction (STEMI) cases undergoing conventional CABG.

Conclusions:

  • Off-pump CABG (OPCAB) shows potential benefits for unstable angina (UA) patients with ACS, especially when supported by intra-aortic balloon pumping (IABP).
  • On-pump beating CABG may be a reasonable alternative for acute myocardial infarction (AMI) patients to prevent conversion and ischemic injury.
  • The choice of surgical strategy should be tailored to the specific ACS subtype (UA vs. AMI) and patient factors.
Abstract

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