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Published on: March 27, 2018
Early clinical outcomes in emergency CABG in the United Kingdom
Kieran Strong1, Kaitlyn Gilbert2, Maria Comanici1
1Department of Cardiac Surgery, Bristol Heart Institute, Bristol, United Kingdom.
Insights
Emergency coronary artery bypass grafting (CABG) is high-risk. Off-pump coronary artery bypass grafting (OPCAB) showed lower in-hospital mortality and fewer returns to the operating room compared to on-pump CABG.
Area of Science:
- Cardiovascular Surgery
- Surgical Outcomes Research
- Cardiac Procedure Analysis
Background:
- Limited evidence exists on trends and outcomes for emergency coronary artery bypass grafting (CABG).
- Understanding revascularisation techniques in emergency CABG is crucial for improving patient care.
- Early clinical outcomes for emergency CABG require further investigation.
Purpose of the Study:
- To analyze trends in emergency isolated CABG procedures in the UK.
- To evaluate early clinical outcomes associated with different revascularisation techniques (on-pump vs. off-pump).
- To identify factors influencing mortality and morbidity in emergency CABG patients.
Main Methods:
- Retrospective analysis of 8,221 first-time, emergency isolated CABG patients from the UK National Adult Cardiac Surgery Audit (1996-2019).
- Comparison of outcomes between off-pump coronary artery bypass grafting (OPCAB) and on-pump coronary artery bypass grafting (ONCAB).
- Statistical analysis using inverse probability treatment weighting to balance patient groups.
Main Results:
- The number of emergency CABG procedures fluctuated, with a general decline after 2004.
- Overall in-hospital mortality was 10.9%; OPCAB was associated with lower mortality (8.7% vs. 11.2%) and reduced return to theatre rates (7.3% vs. 9.8%) compared to ONCAB.
- No significant differences were observed in stroke or need for postoperative dialysis between OPCAB and ONCAB groups.
Conclusions:
- Emergency CABG is a high-risk procedure with substantial in-hospital mortality.
- Off-pump coronary artery bypass grafting (OPCAB) may be associated with improved early clinical outcomes, including lower mortality and fewer reoperations.
- Further research is warranted to optimize revascularisation strategies in emergency CABG.
Introduction:
There is a paucity of evidence in the literature on trends, revascularisation techniques, and early clinical outcomes for patients undergoing emergency coronary artery bypass grafting (CABG).
Method:
All patients who underwent first-time, emergency isolated CABG in the United Kingdom from 1996 to April 2019 were identified from the National Adult Cardiac Surgery Audit database. Trend, early clinical outcomes, and revascularisation technique (on-pump and off-pump) were analysed.
Results:
A total of 8,221 patients were included; the median age was 67.9 years and 71% were male. The number of emergency CABG procedures fluctuated over the study period, ranging from approximately 350 cases per year in the early 2000s to around 525 in 2004. Since then, the number has declined, reaching approximately 325 procedures per year. Off-pump coronary bypass (OPCAB) was used in 12% of cases. The overall mortality was 10.9%, and the incidence of return to theatre was 9.4%. Transient ischaemic attack (TIA) occurred in 1.0% of patients, while stroke was observed in 1.7%. The incidence of postoperative dialysis was 8.5%, and deep sternal wound infection occurred in 1.0% of patients. After inverse probability treatment weighting (generating two balanced groups), OPCAB when compared with ONCAB was associated with a lower in-hospital mortality (8.7% vs. 11.2%, p = 0.043) and lower incidence of return to theatre (7.3% vs. 9.8%, p = 0.035), with no difference in stroke (1.5% vs. 1.7%, p = 0.549) and need for post-operative dialysis (8.3% vs. 8.8%, p = 0.641).
Conclusion:
Emergency CABG remains a high-risk operation with significant in-hospital mortality. The use of OPCAB seems to be associated with lower in-hospital mortality and incidence of return to theatre.
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