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Published on: November 24, 2014
Coronary artery bypass without extracorporeal circulation pump in acute coronary syndromes: a single-center
Juan Pedro Fescina1, Marcia Gorina1, Alan Rodrigo Sigal1
1Department of Cardiology and Cardiovascular Surgery, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
Insights
Off-pump coronary artery bypass grafting (CABG) is a feasible option for acute coronary syndrome (ACS) patients in specialized centers, showing low mortality. Age and ejection fraction significantly impact hospital outcomes in these procedures.
Area of Science:
- Cardiology
- Cardiac Surgery
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is established for extensive coronary artery disease.
- Evidence for CABG in acute coronary syndrome (ACS) is limited, particularly regarding patient selection and outcomes.
- This study evaluates off-pump CABG (OPCAB) in ACS patients at a high-complexity center.
Purpose of the Study:
- To examine the feasibility and outcomes of off-pump CABG (OPCAB) in patients experiencing acute coronary syndrome (ACS).
- To identify risk factors for in-hospital mortality and morbidity following OPCAB in ACS patients.
- To assess the efficacy of OPCAB in achieving complete revascularization with arterial grafts.
Main Methods:
- A single-center, longitudinal prospective cohort study of ACS patients undergoing OPCAB from 2002 to 2022.
- Analysis of demographic, clinical, and surgical data, focusing on major adverse cardiovascular events (MACE) and in-hospital morbidity.
- Multivariate logistic regression was used to identify independent risk factors for in-hospital mortality and morbidity.
Main Results:
- The study included 1,738 patients, with 6.5% undergoing emergency surgery within 24 hours and 3.4% requiring conversion to cardiopulmonary bypass.
- Hospital mortality was 3.5%.
- Advanced age (OR 1.082) and lower baseline ejection fraction (OR 0.952) were significant predictors of in-hospital mortality.
Conclusions:
- Off-pump CABG (OPCAB) is a viable and safe procedure in specialized centers for ACS patients, demonstrating low mortality and minimal need for cardiopulmonary bypass conversion.
- High rates of complete revascularization were achieved using arterial grafts.
- While OPCAB shows promise, age and baseline ejection fraction are critical factors influencing hospital outcomes, warranting further long-term randomized studies.
Background:
Coronary artery bypass grafting (CABG) has been shown to reduce mortality and improve quality of life in patients with extensive coronary artery disease. However, evidence regarding its benefits in the context of acute coronary syndrome (ACS) remains limited, especially considering patient selection, graft patency and in-hospital mortality reduction. This study examines the experience of patients undergoing off-pump CABG during ACS in a high-complexity cardiology center in Argentina.
Methods:
This study analyzed a single-center longitudinal prospective cohort of ACS patients undergoing off-pump CABG (OPCAB) between January 2002 and December 2022. The demographic, clinical, and surgical data were examined, focusing on major adverse cardiovascular events (MACE) and in-hospital morbidity including periprocedural AMI, reoperation for bleeding, among others. Independent risk factors for in-hospital mortality and morbidity were identified through multivariate analysis using stepwise logistic regression.
Results:
Among 1,738 patients, predominantly male (85.5%), 28.3% had diabetes, and 24.2% were smokers. The average age was 64 years, with a mean ejection fraction of 55%. 6.5% of procedures were performed as emergency surgeries within 24 h of hospital admission and 3.4% required conversion to cardiopulmonary bypass. Hospital mortality was 3.5%, and multivariate analysis showed that age (OR 1.082; 95% CI: 1.036-1.129, p = 0.001) and baseline ejection fraction (OR 0.952; 95% CI: 0.924-0.981, p = 0.001) were associated with this event.
Conclusions:
In our experience, OPCAB proved to be a feasible option in specialized centers with expertise, characterized by low mortality, minimal need for conversion to CPB, and high success rates in complete revascularization using arterial grafts.Age and baseline ejection fraction significantly influence hospital outcomes, although these results should be correlated with long-term randomized studies.
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