Comparison of Hospital Outcomes of Patients Who Undergo Urgent CABG Compared to Patients Who Undergo Elective CABG

IF 0.4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiac Surgery Pub Date : 2026-10-20 DOI:10.1155/jocs/2458116

Amir Ghaffari Jolfayi, Nima Taheri, Zahra Hosseini, Arezoo Rezaei, Atefeh Kashanizadeh, Zahra Amir Sardari, Erfan Kohansal, Amir Askarinejad, Ali Mohammad Nasirian, Mansoor Namazi, Ata Firouzi

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引用次数: 0

Abstract

Background

Coronary artery bypass grafting (CABG) is one of the most common cardiac surgeries worldwide. Whether performed electively or urgently, CABG is associated with significant differences in postoperative outcomes. Urgent CABG is associated with higher postoperative morbidity and mortality, often influenced by preoperative cardiac risk factors. This study compares the demographics, clinical characteristics, and outcomes of patients undergoing urgent versus elective CABG.

Methods

This retrospective study analyzed data from 4872 patients who underwent CABG between 2019 and 2022 at Rajaie Cardiovascular Medical and Research Institute. Urgent CABG was defined as surgery performed within 24–72 h (mostly within 48 h) of a precipitating clinical event. The primary outcome was in-hospital mortality, while secondary outcomes included postoperative complications such as cardiac arrest and acute kidney injury. Echocardiographic indices and laboratory parameters were also evaluated. Multivariable logistic regression analysis was performed to identify independent risk factors associated with in-hospital mortality.

Results

In this study of 4872 patients undergoing CABG, 81.6% had elective and 18.4% had urgent surgery. Urgent CABG was associated with significantly higher in-hospital mortality compared with elective procedures (6.8% vs. 2.7%, p = 0.01), while the rate of acute kidney injury was similar. In multivariable logistic regression analysis, increasing age, longer cardiopulmonary bypass time, renal dysfunction, and urgent surgery independently increased the risk of in-hospital mortality, while higher preoperative LVEF was protective.

Conclusion

Primary outcome and mortality after CABG are determined by a combination of patient- and procedure-related factors. Older age, renal dysfunction, prolonged cardiopulmonary bypass time, lower preoperative ejection fraction, and urgent surgical status significantly increase the risk of early postoperative death, with urgent CABG more than doubling mortality compared with elective surgery. These findings emphasize the importance of individualized risk assessment, timely referral, optimal preoperative stabilization, and meticulous perioperative management, particularly in high-risk and urgent cases, to improve short-term surgical outcomes and reduce in-hospital mortality.

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急诊冠脉搭桥患者与择期冠脉搭桥患者住院疗效的比较

背景冠状动脉旁路移植术（CABG）是世界范围内最常见的心脏手术之一。无论是选择性手术还是紧急手术，CABG在术后结果上都有显著差异。紧急冠脉搭桥与较高的术后发病率和死亡率相关，通常受术前心脏危险因素的影响。本研究比较了急诊和择期冠脉搭桥患者的人口学特征、临床特征和结果。方法回顾性分析2019年至2022年Rajaie心血管医学研究所4872例CABG患者的数据。紧急冠脉搭桥被定义为在临床事件发生后24-72小时内（大多在48小时内）进行的手术。主要结局是住院死亡率，次要结局包括术后并发症，如心脏骤停和急性肾损伤。超声心动图指标和实验室参数也进行了评估。采用多变量logistic回归分析确定与院内死亡率相关的独立危险因素。结果4872例CABG患者中，81.6%为选择性手术，18.4%为紧急手术。与择期手术相比，紧急冠脉搭桥的住院死亡率明显更高（6.8% vs. 2.7%, p = 0.01），而急性肾损伤的发生率相似。在多变量logistic回归分析中，年龄增加、体外循环时间延长、肾功能不全和紧急手术均增加院内死亡风险，而术前较高的LVEF具有保护作用。结论：CABG术后的主要预后和死亡率是由患者和手术相关因素共同决定的。年龄较大、肾功能不全、体外循环时间延长、术前射血分数较低和手术状态紧急显著增加术后早期死亡的风险，与择期手术相比，紧急CABG的死亡率增加了一倍以上。这些发现强调了个体化风险评估、及时转诊、最佳术前稳定和细致的围手术期管理的重要性，特别是在高风险和紧急病例中，以改善短期手术结果并降低住院死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.