Urgent versus elective coronary artery bypass grafting in acute coronary artery syndrome

Abstract

Background

In this retrospective study, we aimed to evaluate the clinical outcomes, risk factors of mortality and prognosis after urgent coronary artery bypass grafting (CABG) in acute coronary syndrome (ACS) patients.

Methods

Our study included 100 patients who underwent CABG for ACS (50 urgent and 50 elective). All patients were followed for 30 days after surgery, both clinically and echocardiographically. Data were analyzed using the SPSS software in accordance to the Society of Thoracic Surgeons (STS) National Cardiac Surgery Database guidelines.

Results

Patients in the urgent CABG group were of younger age (p = .03) and had a higher frequency of smoking (p = .04) and dyslipidemia (p = .004); otherwise, all baseline characteristics were comparable between the two groups. The cardiopulmonary bypass (CPB) (p = .003) and aortic cross-clamp times (p = .02) were significantly longer in the urgent CABG group compared to the elective CABG group. Although both groups had a relatively similar survival rate (p = .056), urgent CABG patients were more liable to postoperative myocardial infarction (p = .02), as well as prolonged ventilation time (p = .002) and hospital stay (p < .001). Our analysis showed that preoperative low ejection fraction (EF) (p = .03), use of inotropes (p = .002) and prolonged CPB time (p = .04) were independent risk factors for mortality after urgent CABG.

Conclusions

Urgent CABG increased the risk of myocardial infarction and prolonged hospital stay in comparison to elective CABG. Moreover, preoperative low EF and prolonged CPB time were associated with a significant increase in the risk of mortality after urgent CABG.