Subscribe to RSS
DOI: 10.1055/s-0037-1598766
Immediate Isolated CABG for Acute Coronary Syndrome: Initial Clinical Outcome
Publication History
Publication Date:
03 February 2017 (online)
Introduction: Timing of CABG surgery for acute coronary syndrome still is discussed controversially. Herein we describe the results of an immediate surgery approach.
Patients and methods: Between January 2007 and December 2015 a total of 8,215 isolated CABG procedures were performed at our institution. Out of these, 1,973 (24.0%) procedures were categorized as urgent or emergency and 454 (5.5%) patients underwent surgery immediately after admission in consequence of ongoing acute coronary syndrome.
Results: Mean patient's age was 67.0 ± 10.2 years. Surgery consisted of 3.1 ± 0.7 bypass anastomoses and took 182 ± 58min skin-to-skin time in mean. There were three (0.7%) intraoperative deaths. Mechanical circulatory support by means of arterial-venous ECLS became necessary in 5.3% of the patients (n = 24). Hospital mortality was 11.0% (n = 50). Postoperative morbidity mainly consisted of renal failure (n = 79; 17.4%), respiratory failure (n = 28; 6.2%), stroke (n = 11; 2.4%) and re-exploration for bleeding (n = 22; 4.8%). Univariate analysis revealed age (p = 0.05), lower mean count of anastomoses (p = 0.015), need for mechanical circulatory support (p = 0.049), acute myocardial infarction (p = 0.006), LV-EF < 40% (p < 0.01), preexisting chronic kidney disease (p < 0.01), postoperative renal failure (p < 0.01) and re-exploration for bleeding (p < 0.01) as significant risk factors for mortality.
Conclusion: Immediate CABG surgery for acute coronary syndrome still is associated with inferior hospital outcome by means of mortality and morbidity. Sophisticated patient selection and hybrid-strategies in the truest sense of a “heart team”-approach might be able to improve clinical outcomes.