title: Contemporary outcomes of urgent coronary artery bypass graft surgery following non-ST elevation myocardial infarction: urgent coronary artery bypass graft surgery consistently outperforms Global Registry of Acute Coronary Events predicted survival.
abstract: OBJECTIVE
  The Global Registry of Acute Coronary Events (GRACE) registry reported that the in-hospital risk of death from non-ST elevation myocardial infarction (NSTEMI) is 5%, with an 11% mortality by 6 months. Prospective Registry of Acute Ischaemic Syndromes in the UK demonstrated that the overall risk of death from NSTEMI over 4 years is 25%. In GRACE, while 28% of patients received percutaneous intervention, only 10% received coronary artery bypass graft (CABG). Results of urgent CABG surgery following NSTEMI are difficult to interpret as these often include patients who have had STEMIs and urgent surgery. With increasing multidisciplinary assessment of patients with acute coronary syndromes (ACS), accurate data collection on the outcome of such patients could inform correct revascularization strategy.
  
  
  METHODS
  Three hundred and forty-two consecutive patients who had undergone urgent CABG from April 2004 to April 2009 at a single institution were identified. The GRACE predicted mortality was calculated from hospital records and patients categorized into three groups based upon their predicted risk. Late survival data were obtained from the UK Office of National Statistics.
  
  
  RESULTS
  The GRACE score could be calculated in 270 patients with a confirmed diagnosis of NSTEMI. Of the 304 probable patients with NSTEMI, there were 5 in-hospital deaths (1.6%). Survival at 6 months was higher than GRACE predicted mortality in all groups. At 6 months the predicted versus observed mortality in the low-risk group was 4 versus 2% (P = 0.05), in the medium-risk group it was 12.5 versus 1.9% (P = 0.0001) and in the high-risk group it was 25 versus 20% (P = 0.45).
  
  
  CONCLUSIONS
  In-hospital CABG performed after NSTEMI is associated with a low-mortality risk and survival significantly better than that predicted by the GRACE score.
authors.forename: Eshan L
authors.initials: EL
authors.lastname: Senanayake
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Howell
authors.forename: Jonathan
authors.initials: J
authors.lastname: Evans
authors.forename: Daniel
authors.initials: D
authors.lastname: Ray
authors.forename: Jorge
authors.initials: J
authors.lastname: Mascaro
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Graham
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rooney
authors.forename: Domenico
authors.initials: D
authors.lastname: Pagano
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome