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Emergency Coronary Artery Bypass Grafting: Indications and Outcomes from 2003 through 2013

Erin M Schumer, John H Chaney, Jaimin R Trivedi

    Texas Heart Institute Journal
    |June 16, 2016
    PubMed

    Insights

    Emergency coronary artery bypass grafting (CABG) carries high risks. Angiographic accidents are an increasing cause, demanding focused efforts to improve outcomes for this high-risk group.

    Area of Science:

    • Cardiovascular Surgery
    • Cardiac Surgery Outcomes
    • Emergency Cardiac Procedures

    Background:

    • Emergency coronary artery bypass grafting (CABG) is linked to elevated in-hospital mortality and adverse events.
    • Understanding the evolving indications and outcomes of emergency CABG is crucial for improving patient care.

    Purpose of the Study:

    • To retrospectively evaluate the indications and outcomes of patients undergoing emergency coronary artery bypass grafting (CABG).
    • To identify trends in emergency CABG over time and assess specific risk factors.

    Main Methods:

    • Retrospective analysis of the Society of Thoracic Surgeons database from a single center (Jewish Hospital).
    • Inclusion of patients who underwent isolated coronary artery bypass grafting (CABG) between January 2003 and December 2013.
    • Univariate analysis to compare outcomes and indications between different time periods.

    Main Results:

    • Out of 5,940 CABG procedures, 212 (3.6%) were emergency cases.
    • Emergency CABG patients exhibited higher rates of intra-aortic balloon pump use, bleeding, dialysis, in-hospital death, and prolonged hospital stay.
    • The proportion of emergency CABG decreased from 2003-2007 to 2008-2013 (4.5% vs. 2.2%), but the incidence of angiographic accidents as an indication significantly increased (29.2% vs. 5.3%).
    • Ongoing ischemia remained the primary indication, but angiographic accidents emerged as a significant and increasing cause.
    • 15% of emergency CABG deaths were associated with angiographic accidents.

    Conclusions:

    • Emergency coronary artery bypass grafting (CABG) continues to be associated with high in-hospital mortality and adverse events.
    • While the overall rate of emergency CABG declined, the proportion driven by angiographic accidents has risen substantially.
    • Targeted strategies to mitigate risks associated with angiographic accidents are essential to improve outcomes in this vulnerable patient population.

    Keywords:
    Coronary artery bypass/statistics & numerical data/trendsemergencyhospital mortalitymyocardial reperfusion injurymyocardial revascularization/trendspercutaneous coronary intervention/trendsretrospective studiestreatment outcome

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