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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
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.