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Long-term results of emergency coronary artery bypass grafting
T Murakami1, T Fujiwara, Y Fukuhiro
1Department of Thoracic and Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan.
Insights
Emergency coronary artery bypass grafting (CABG) for ischemic heart disease carries high operative mortality but offers a fair long-term prognosis for survivors. Key predictors of hospital death include lack of prior myocardial infarction history, intraaortic balloon pumping, and acute coronary occlusion.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Surgery Outcomes
Background:
- Ischemic heart disease necessitates interventions like coronary artery bypass grafting (CABG).
- Emergency CABG is performed in a subset of patients with acute cardiac conditions.
Purpose of the Study:
- To evaluate the outcomes and predictors of mortality in patients undergoing emergency coronary artery bypass grafting (CABG).
- To assess the long-term survival and functional status after emergency CABG.
Main Methods:
- Retrospective analysis of 364 patients undergoing CABG over 20 years, with a focus on 28 emergency cases.
- Univariate analysis to identify predictors of hospital mortality.
- 12-year actuarial survival follow-up for a subset of patients.
Main Results:
- Emergency CABG was performed for unstable angina, impending myocardial infarction, and congestive heart failure.
- Hospital mortality occurred in 11 patients.
- Lack of prior myocardial infarction, intraaortic balloon pumping (IABP), and acute coronary occlusion were significant predictors of hospital death.
- Actuarial survival at 12 years was 63% with no cardiac deaths among the 17 followed patients.
- Survivors demonstrated good functional status (NYHA class I or II).
Conclusions:
- Despite a high operative mortality rate, emergency CABG offers a reasonable long-term prognosis for patients who survive the surgery.
- Identifying predictors of mortality can aid in risk stratification for emergency CABG patients.
Abstract:
During a 20-year period, 364 patients underwent coronary artery bypass grafting (CABG) for the treatment of ischemic heart disease. Among these patients, 28 underwent emergency surgery. The reasons for performing emergency CABG were unstable angina in 15 patients, impending myocardial infarction in 12 patients and congestive heart failure in 1 patient. Eleven patients died postoperatively. Eight variables were examined by univariate analysis for their influence on the occurrence of a hospital death. Lack of a history of myocardial infarction, intraaortic balloon pumping (IABP) and acute coronary occlusion were all found to be predictors of hospital death. Seventeen patients were followed up for 12 years. There was no cardiac death and actuarial survival at 12 years was 63%. The 14 survivors are now in NYHA functional class I or II. Although the operative mortality rate is high after emergency CABG, a fair prognosis can be expected if the patients survive surgery.