Surgical revascularization for acute coronary syndrome

Comparative surgical and long-term results
  • Keiji Kamohara
  • Masaru Yoshikai
  • Junji Yunoki
  • Hideyuki Fumoto
  • Masakatsu Hamada
  • Junichi Murayama
  • Tsuyoshi Itoh
Original Article

Abstract

Objective: The purpose of this study was to evaluate the adequate timing of coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS). Methods: In our institution, emergency CABG has been avoided when possible for ACS patients favoring stabilization with medical therapies, including intra-aortic balloon pumping or percutaneous coronary intervention. After thorough preoperative examinations, an urgent CABG is performed. A total of 67 patients with ACS underwent CABG, comprised of 33 patients receiving an emergency CABG (emergent group: E-G) and 34 patients receiving an urgent CABG (urgent group: U-G). The early and long-term results were evaluated retrospectively. Results: Preoperatively, the incidences of acute myocardial infarction and cardiogenic shock were significantly higher in E-G. No significant differences were found in the intraoperative factors except for the number of distal anastomoses (2.5 in E-G vs. 3.1 in U-G, p=0.01). The hospital mortality was 9.1% in E-G, and 2.9% in U-G, with no significant difference between the groups. Moreover, no patient in U-G necessitated emergency CABG while waiting for surgery. The patency rate of the grafts was 100% in E-G, and 96.2% in U-G. The 5-year survival rate excluding in-hospital death was 80.3% in E-G, and 78% in U-G (p>0.05). The 5-year cardiac event-free rate was 80.3% in E-G, and 80.9% in U-G (p>0.05). Conclusion: An emergency CABG can be reserved for ACS patients when symptoms and hemodynamic state are stabilized with medical therapies. Improvements in long-term results can be expected after high quality and complete surgical revascularization.

Key words

acute coronary syndrome emergency coronary artery bypass grafting urgent coronary artery bypass grafting 

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Copyright information

© Japanese Association for Thoracic Surgery 2006

Authors and Affiliations

  • Keiji Kamohara
    • 1
  • Masaru Yoshikai
    • 1
  • Junji Yunoki
    • 1
  • Hideyuki Fumoto
    • 1
  • Masakatsu Hamada
    • 1
  • Junichi Murayama
    • 2
  • Tsuyoshi Itoh
    • 2
  1. 1.Department of Cardiovascular SurgeryTenjin-kai Shin-Koga HospitalKurume, FukuokaJapan
  2. 2.Department of Thoracic and Cardiovascular SurgerySaga Medical SchoolSagaJapan

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