title: Urgent and emergency coronary artery bypass grafting for acute coronary syndromes.
abstract: BACKGROUND
  Urgent and emergency coronary artery bypass grafting may be associated with significant mortality and morbidity. We report our recent experience with this group of patients.
  
  
  METHODS
  A retrospective analysis of 441 patients undergoing urgent and emergency surgery over a 3-year period was carried out. Multivariate analysis was used to identify subgroups of patients who were most at risk of death.
  
  
  RESULTS
  The 30-day mortality was 3.3 and 16.3% in the urgent and emergency groups, respectively. Urgent surgery was associated with significantly shorter duration of ventilation (16 h vs 69 h) and stay at the intensive care unit (31 h vs 102 h). The incidence of pneumonia, pulmonary embolism, renal failure and neurological events were also less in the urgent group. The preoperative use of the intra-aortic balloon pump was low (0.8% in the urgent group and 4.8% in the emergency group). Multivariate analysis showed that patients over 70 years of age (odds ratio 3.2, 95% confidence interval 1.1-9.5) with left main stenosis (odds ratio 4.4, 95% confidence interval 1.5-12.4) complicated by cardiogenic shock (odds ratio 17.8, 95% confidence interval 5.2-61.1) were at highest risk of death. Patients transferred directly to theatre from cardiac catheter laboratory following failed percutaneous interventions were found to be most at risk. Mortality in this group was 29%, with 50% patients being in shock and 36% having left main stenosis.
  
  
  CONCLUSIONS
  Satisfactory results have been obtained in urgent coronary artery bypass grafting, but acute coronary syndromes complicated by cardiogenic shock remain a high-risk group. Further studies are needed to define the optimal operative management in this group of patients.
authors.affiliation: Cardiothoracic Surgery Unit, Monah Medical Centre, Clayton, Victoria, Australia.
authors.forename: Yi
authors.initials: Y
authors.lastname: Chen
authors.forename: Aubrey A
authors.initials: AA
authors.lastname: Almeida
authors.forename: Jacob
authors.initials: J
authors.lastname: Goldstein
authors.forename: Gilbert C
authors.initials: GC
authors.lastname: Shardey
authors.forename: Adrian W
authors.initials: AW
authors.lastname: Pick
authors.forename: Randall
authors.initials: R
authors.lastname: Moshinsky
authors.forename: Nand K
authors.initials: NK
authors.lastname: Kejriwal
authors.forename: Cassie
authors.initials: C
authors.lastname: Lowe
authors.forename: Damien
authors.initials: D
authors.lastname: Jolley
authors.forename: Julian A
authors.initials: JA
authors.lastname: Smith
mesh_terms: D000208:Acute Disease; D000789:Angina, Unstable / Q000601:surgery*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013577:Syndrome