Thorac Cardiovasc Surg 2014; 62 - OP138
DOI: 10.1055/s-0034-1367212

Surgical outcomes of patients with acute coronary syndromes undergoing coronary artery bypass grafting: a current report of the North-Rhine-Westphalia surgical myocardial infarction registry

M. Thielmann 1, O.J. Liakopoulos 1, I. Slottosch 2, H. Welp 3, D. Wendt 1, W. Schiller 4, S. Martens 3, A. Welz 4, T. Wahlers 2, M. Neuhäuser 5 H. Jakob 1on behalf of the North-Rhine-Westphalia Study Group
  • 1Westdeutsches Herzzentrum Essen, Klinik für Thorax- und Kardiovaskuläre Chirurgie, Essen, Germany
  • 2Herzzentrum Uniklinik Köln, Herz- und Thoraxchirurgie, Köln, Germany
  • 3Universitätsklinikum Münster, Klinik für Herzchirurgie, Münster, Germany
  • 4Universitätsklinikum Bonn, Klinik und Poliklinik für Herzchirurgie, Bonn, Germany
  • 5Rhein-Ahr-Campus, Hochschule Koblenz, University of Applied Sciences, Fachbereich Mathematik und Technik, Remagen, Germany

Objectives: To evaluate in-hospital mortality of patients referred to urgent coronary artery bypass grafting (CABG) with acute coronary syndromes (ACS), including ST-elevation or non ST-elevation myocardial infarction (STEMI/NSTEMI) or unstable angina (UA).

Methods: Between 01/2010 and 05/2012 patients undergoing urgent CABG with ACS were prospectively entered into a registry by four participating cardiac surgery centres in North-Rhine-Westphalia. Demographic data and over one-hundred perioperative variables were recorded, including in-hospital all-cause mortality. After univariate analysis, relevant perioperative variables were entered into a multivariate logistic regression model to identify independent predictors for in-hospital mortality.

Results: A total of 1197 patients (age 68 ± 11 yrs, males 78%, log. EuroSCORE 24 ± 21%) were admitted to CABG surgery with STEMI (25%), NSTEMI (49%) or UA (26%). Three-vessel coronary artery disease was present in 80% with main-stem involvement in 46% of patients. On-pump CABG surgery was performed in 94% (CPB-time, 103 ± 43 min, aortic cross-clamp time, 60 ± 26 min; 53% blood cardioplegia) with a mean of 2.5 ± 0.7 bypass grafts and 93% LITA use. Overall in-hospital mortality was 7.4%, with 12.8% in STEMI patients, 5.6% in NSTEMI and 5.0% in patients with UA (P < 0.001). Multivariate logistic regression analysis revealed age, gender, preoperative troponin I, LVEF, on-pump surgery and the need for ECMO therapy to be independently predictive for in-hospital mortality (P < 0.05). Importantly, the preoperative use of aspirin/clopidogrel, ß-blockers, or statins, the use of preoperative IABP support as well as the type of cardioplegia (crystalloid/blood) were not associated with in-hospital mortality.

Conclusions: CABG in patients with ACS is still linked to substantial in-hospital mortality. Especially for patients with STEMI reliable identification of preoperative predictors is mandatory to improve surgery outcomes.