title: Optimal coronary artery bypass grafting strategy for acute coronary syndrome.
abstract: OBJECTIVE
  Conventional coronary artery bypass grafting (CABG) using cardiopulmonary bypass and cardiac arrest is associated with higher mortality and morbidity rates in acute coronary syndrome (ACS) patients undergoing surgery. Although off-pump CABG (OPCAB) is beneficial for high-risk patients, its efficacy for ACS is unknown, with on-pump beating CABG an adjunctive method. We investigated the effects of OPCAB and on-pump beating CABG for ACS.
  
  
  METHODS
  We evaluated 121 consecutive patients with ACS (91 males, 30 females; mean age 69.5 ± 10.3 years) who underwent CABG since 2000. Seventy-five had unstable angina (UA) and 46 acute myocardial infarction (AMI) [non-ST elevation (NSTEMI): 22, ST elevation (STEMI): 24]. We assessed CABG for acute coronary syndrome under our primary OPCAB strategy, and compared perioperative status between UA and AMI patients.
  
  
  RESULTS
  (1) Sixty-five (87 %) with UA underwent OPCAB, 8 on-pump beating CABG, and 2 conventional CABG. Conversion from OPCAB was seen in 4 patients. In-hospital mortality was 1.3 %. (2) All UA patients who had intra-aortic balloon pumping (IABP) underwent OPCAB. No patients with preoperative IABP experienced conversion from OPCAB. (3) In AMI patients, hospital mortality was higher (8.9 %) and the ratios for OPCAB, on-pump beating CABG, and conventional CABG were 39, 57, and 4 %, respectively. Mortality was exclusively seen in patients with STEMI who underwent conventional CABG.
  
  
  CONCLUSIONS
  OPCAB might have beneficial effects for ACS patients with UA, while IABP was found essential for completing OPCAB. In AMI patients, on-pump beating CABG might be reasonable for avoiding conversion from OPCAB and ischemic perfusion injury.
authors.affiliation: Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamada-Oka, Suita, Osaka, 565-0871, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nishi
authors.forename: Taichi
authors.initials: T
authors.lastname: Sakaguchi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyagawa
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Yoshikawa
authors.forename: Satsuki
authors.initials: S
authors.lastname: Fukushima
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yoshioka
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Saito
authors.forename: Koichi
authors.initials: K
authors.lastname: Toda
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Sawa
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000601:surgery; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery