Unstable angina and non-ST segment elevation: surgical revascularization with different strategies.
OBJECTIVE
Unstable angina/non-ST elevation myocardial infarction (UA/NSTEMI) still causes significant hospital morbidity and mortality. We evaluated whether surgical outcome can be modified by different myocardial protection strategies.


METHODS
This was a prospective clinical study conducted in the cardiac surgery units of two university hospitals. Two hundred and sixty-two consecutive patients undergoing CABG for UA/NSTEMI between January 2002 and June 2004 were prospectively divided in three groups: 126 patients underwent on-pump CABG with antegrade blood cardioplegia (Group A); 67 underwent antegrade and retrograde blood cardioplegia (Group B); 69 off-pump CABG (Group C). Hospital outcome was analysed. Differences in outcome variables were detected with ANOVA; Tukey's multiple comparison test and Tamhane's T2 test were used when appropriate.


RESULTS
Group A showed higher mortality (P=.001; P=.014 vs. Group B; P=.003 vs. Group C) and perioperative myocardial infarction (P=.001; P=.016 vs. Group B; P=.05 vs. Group C). Hospital stay was shorter in Group B and Group C, compared to Group A (P=.005; P=.043 and P=.05, respectively). Group A required higher doses of inotropes compared to Group B and Group C (P=.0001; P=.0001 and P=.03, respectively), whereas Group B and Group C did not require any inotropic support at all (P=.0001; P=.002 and P=.001 vs. Group A, respectively). Total morbidity was higher in Group A (P=.006; P=.007 vs. Group B; P=.005 vs. Group C). Wall motion score index recovered only in Group B (P=.0001) and Group C (P=.001). Troponin I was higher in Group A at 12 h (P=.0001; P<.001 vs. Group B and Group C), 24 (P=.0001; P=.001 vs. Group B and Group C), 48 (P=.0001; P=.001 vs. Group B, P=.002 vs. Group C) and 72 h (P=.0001; P=.004 vs. Group B; P=.05 vs. Group C).


CONCLUSIONS
Isolated antegrade cardioplegia should be questioned in UA/NSTEMI. Outcome using off-pump revascularization was as good as that of combined antegrade and retrograde warm blood cardioplegia.
Onorati
Francesco
F
Cardiac Surgery Unit, Magna Graecia University, Policlinico Mater Domini Via T.C., Catanzaro 88100, Italy. frankono@libero.it
De Feo
Marisa
M
Mastroroberto
Pasquale
P
di Virgilio
Antonio
A
Esposito
Antonio
A
Polistena
Massimo
M
Renzulli
Attilio
A
Cotrufo
Maurizio
M
D000368:Aged; D000704:Analysis of Variance; D000789:Angina, Unstable / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000379:methods; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D011446:Prospective Studies; D016896:Treatment Outcome