Clinical Research in Cardiology

, Volume 97, Issue 9, pp 601–608

Coronary surgery for acute coronary syndrome: which determinants of outcome remain?

  • K. Alexiou
  • U. Kappert
  • A. Staroske
  • D. Joskowiak
  • M. Wilbring
  • K. Matschke
  • S. M. Tugtekin
ORIGINAL PAPER

DOI: 10.1007/s00392-008-0657-6

Cite this article as:
Alexiou, K., Kappert, U., Staroske, A. et al. Clin Res Cardiol (2008) 97: 601. doi:10.1007/s00392-008-0657-6

Abstract

Background

The mortality risk associated with coronary artery bypass grafting (CABG) after acute myocardial infarction remains controversial. The objective of the present study was therefore to analyze the outcome and predictors of in-hospital mortality in patients (pts) referred to CABG with acute coronary syndrome (ACS).

Patients and methods

Between January 2003 and May 2005, a total of 3,127 pts underwent primary isolated CABG at our institution, including 220 pts with ACS. Out of these, unstable angina pectoris was present in 88 pts (group I), 97 pts (group II) had non-ST-elevation infarction, whereas 35 pts (group III) had ST-elevation infarction. Clinical data, in-hospital morbidity and mortality were recorded and studied retrospectively.

Results

Overall in-hospital mortality was 6.4% (n = 14) in the complete cohort, being 2.2% in group I (n = 2), 9.2% in group II (n = 9) and 8.5% (n = 3) in group III (P < 0.05). Logistic regression and receiver operating characteristic analyses identified age, NYHA, ejection fraction < 45%, catecholamine support, cardiogenic shock, renal disease and the additive EuroSCORE > 10 (P < 0.0001) as significant predictors related to in-hospital mortality. The mean time from the onset of symptoms to revascularization differed significantly between survivors (5.1 ± 2.7 h) and no survivors (11.4 ± 3.2 h) (P < 0.0007) in the STEMI group. Preoperative cTnI did not provide any prognostic information.

Conclusion

CABG in pts with ACS can be performed with good clinical results. The clinical outcome is particular depending on the different groups of ACS. Therefore an individual risk stratification of each pts in ACS is necessary. The time interval of 6 h seems to be crucial as prognostic variable in the STEMI-group.

Keywords

acute coronary syndromecoronary artery bypass graftingpredictors of mortality

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • K. Alexiou
    • 1
    • 2
  • U. Kappert
    • 1
  • A. Staroske
    • 1
  • D. Joskowiak
    • 1
  • M. Wilbring
    • 1
  • K. Matschke
    • 1
  • S. M. Tugtekin
    • 1
  1. 1.Dept. of Cardiac SurgeryUniversity of Technology DresdenDresdenGermany
  2. 2.Dept. of Cardiac SurgeryHeart Center Dresden Ltd., University HospitalDresdenGermany