Clinical Outcomes of Patients Undergoing Urgent Surgical Revascularization for Acute Coronary Syndrome

Objective: To evaluate major adverse clinical outcomes in patient with acute coronary syndrome (ACS) requiring urgent coronary artery bypass graft (CABG).

Methods: Between June 2010 and July 2017, a total number of 1103 patients were included into the prospective surgical myocardial infarction registry. Demographic data, intraoperative variables and postoperative clinical outcomes were compared between survivors and non-survivors after CABG surgery.

Results: From 1103 patients, 1006 (91.2%) patients with ACS undergoing CABG surgery were discharged from the hospital. In contrast, in-hospital mortality was 8.8% in this high-risk cohort. Non-survivors were more likely to be older (72.0 vs 66.9 years, p < 0.0001), suffer from left main stenosis (57.7% versus 46.2%, p < 0.0001) and were more frequently admitted in cardiogenic shock (57.0% versus 46.0%, p < 0.0001) when compared with hospital survivors. In addition, the rate of preoperative atrial fibrillation (10.3% vs 4.9% p < 0.05), and creatinine levels (1.34 mg/dl vs. 1.12 mg/dl, p < 0.05) were higher in non-survivors. Intraoperative variables did not differ between groups, but survivors had significantly shorter CPB (84 ± 32.6 vs. 129.3 ± 37.7 min, p < 0.0001) and cross clamp times (45 ± 18.4 vs. 53.7 ± 19.5 min, p < 0.05). Major postoperative cardiac events were higher in non-survivors with a higher rate for postoperative cardiac resuscitation (36.1% versus 3.2% p < 0.0001), myocardial reinfarctions (21.6 vs. 1.7 p < 0.0001), low cardiac output syndrome (74.2% vs. 9.9% p < 0.0001) and stroke (8.3 vs. 2.1 p < 0.0001).

Conclusion: Our prospective registry demonstrates that urgent CAGB is safe and can be performed with excellent result in patients with ACS.