Emergency Coronary Artery Bypass Grafting: Indications and Outcomes from 2003 through 2013.
Emergency coronary artery bypass grafting (CABG) is associated with increased in-hospital mortality rates and adverse events. This study retrospectively evaluated indications and outcomes in patients who underwent emergency CABG. The Society of Thoracic Surgeons database for a single center (Jewish Hospital) was queried to identify patients undergoing isolated CABG. Univariate analysis was performed. From January 2003 through December 2013, 5,940 patients underwent CABG; 212 presented with emergency status. A high proportion of female patients (28.2%) underwent emergency surgery. Emergency CABG patients experienced high rates of intra-aortic balloon pump support, bleeding, dialysis, in-hospital death, and prolonged length of stay. The proportion of emergency coronary artery bypass grafting declined during years 2008-2013 compared with 2003-2007 (2.2% vs. 4.5%, P < 0.001), but the incidence of angiographic accident (5.3% vs. 29.2%) increased as an indication. Ongoing ischemia remains the most frequent indication for emergency CABG, yet the incidence of angiographic accident has greatly increased. In-hospital mortality rates and adverse events remain high. If we look specifically at emergency CABG cases arising from angiographic accident, we find that 14 (15%) of all 93 emergency CABG deaths occurred in that subset of patients. Efforts to improve outcomes should therefore be focused on this high-risk group.
Erin M
EM
Schumer
John H
JH
Chaney
Jaimin R
JR
Trivedi
Paul L
PL
Linsky
Matthew L
ML
Williams
Mark S
MS
Slaughter
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate / Q000639:trends
Coronary artery bypass/statistics & numerical data/trends; emergency; hospital mortality; myocardial reperfusion injury; myocardial revascularization/trends; percutaneous coronary intervention/trends; retrospective studies; treatment outcome