急性冠症候群における体外循環ポンプを用いない冠動脈バイパス術：単一施設観察研究

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.

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.

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.

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.