Outcome of emergency conventional coronary surgery for acute coronary syndrome due to left main coronary disease.
BACKGROUND
Outcomes of emergency coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) due to left main coronary (LMT) disease remain unclear. This study aimed to assess prognoses for patients undergoing emergency CABG for ACS due to LMT disease.


METHODS
One hundred and four patients undergoing emergency CABG for ACS due to LMT disease were retrospectively reviewed. All patients had intra-aortic balloon pumping (IABP) support and underwent surgery within 48 hours after onset. We determined predictors for operative mortality and calculated cardiac event free, actuarial survival, and cumulative graft patency rates.


RESULTS
We found that 9 patients (8.7%) developed pre-operative cardiogenic shock and 7 of them required percutaneous cardiopulmonary support (PCPS). Operative mortality affected 9 patients (8.7%). Cardiac event free rate and actuarial survival rate at 10 years were 80.7 and 75.4%, respectively. Logistic regression analysis showed that pre-operative cardiogenic shock was the only predictor for operative mortality (p = 0.0146, odds 5.96). Cumulative graft patency rates for internal thoracic artery and saphenous vein (SVG) at 5 years were 92.6 and 72.4%, respectively. One year-graft patency rate for the radial artery (RA) was 100%.


CONCLUSIONS
It is still very hard to treat patients with cardiogenic shock. We suggest that immediate percutaneous coronary intervention (PCI) with mechanical supports is required prior to CABG for survival of patients with left main shock syndrome.
Hata
Mitsumasa
M
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
Shiono
Motomi
M
Sezai
Akira
A
Iida
Mitsuru
M
Yoshitake
Isamu
I
Wakui
Shinji
S
Taoka
Makoto
M
Negishi
Nanao
N
Sezai
Yukiyasu
Y
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy; D016019:Survival Analysis; D016896:Treatment Outcome; D014654:Vascular Patency