Surgical revascularization for acute coronary syndrome: comparative surgical and long-term results.
OBJECTIVE
The purpose of this study was to evaluate the adequate timing of coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS).


METHODS
In our institution, emergency CABG has been avoided when possible for ACS patients favoring stabilization with medical therapies, including intra-aortic balloon pumping or percutaneous coronary intervention. After thorough preoperative examinations, an urgent CABG is performed. A total of 67 patients with ACS underwent CABG, comprised of 33 patients receiving an emergency CABG (emergent group: E-G) and 34 patients receiving an urgent CABG (urgent group: U-G). The early and long-term results were evaluated retrospectively.


RESULTS
Preoperatively, the incidences of acute myocardial infarction and cardiogenic shock were significantly higher in E-G. No significant differences were found in the intraoperative factors except for the number of distal anastomoses (2.5 in E-G vs. 3.1 in U-G, p=0.01). The hospital mortality was 9.1% in E-G, and 2.9% in U-G, with no significant difference between the groups. Moreover, no patient in U-G necessitated emergency CABG while waiting for surgery. The patency rate of the grafts was 100% in E-G, and 96.2% in U-G. The 5-year survival rate excluding in-hospital death was 80.3% in E-G, and 78% in U-G (p>0.05). The 5-year cardiac event-free rate was 80.3% in E-G, and 80.9% in U-G (p>0.05).


CONCLUSIONS
An emergency CABG can be reserved for ACS patients when symptoms and hemodynamic state are stabilized with medical therapies. Improvements in long-term results can be expected after high quality and complete surgical revascularization.
Kamohara
Keiji
K
Department of Cardiovascular Surgery, Tenjin-kai Shin-Koga Hospital, Kurume, Fukuoka, Japan.
Yoshikai
Masaru
M
Yunoki
Junji
J
Fumoto
Hideyuki
H
Hamada
Masakatsu
M
Murayama
Junichi
J
Itoh
Tsuyoshi
T
D000368:Aged; D000789:Angina, Unstable / Q000601:surgery*; D001026:Coronary Artery Bypass; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000601:surgery*; D012189:Retrospective Studies; D013577:Syndrome