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Surgical revascularization for acute coronary syndrome

Comparative surgical and long-term results

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The Japanese Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

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.

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References

  1. Fuster V, Badimon L, Cohen M, Ambrose JA, Badimon JJ, Chesebro J. Insights into the pathogenesis of acute ischemic syndromes. Circulation 1988; 77: 1213–20.

    PubMed  CAS  Google Scholar 

  2. Braxton JH, Hammond GL, Letsou GV, Franco KL, Kopf GS, Elefteriades JA, et al. Optimal timing of coronary artery bypass graft surgery after acute myocardial infarction. Circulation 1995; 92 (9 Suppl): 66–8.

    Google Scholar 

  3. Every NR, Maynard C, Cochran RP, Martin J, Weaver WD. Characteristics, management, and outcome of patients with acute myocardial infarction treated with bypass surgery. Myocardial Infarction Triage and Intervention Investigators. Circulation 1996; 94 (9 Suppl): 81–6.

    Google Scholar 

  4. Bjessmo S, Hammar N, Sandberg E, Ivert T. Reduced risk of coronary artery bypass surgery for unstable angina during a 6-year period. Eur J Cardiothorac Surg 2000; 18: 388–92.

    Article  PubMed  CAS  Google Scholar 

  5. Bonacchi M, Prifti E, Giunti G, Frati G, Sani G. Urgent surgical revascularization of unstable angina. Influence of double mammary arteries. Eur J Cardiothorac Surg 2001; 20: 747–54.

    Article  PubMed  CAS  Google Scholar 

  6. de Feyter PJ, Serruys PW, Unger F, Beyar R, de Valk V, Milo S, et al. Bypass surgery versus stenting for the treatment of multivessel disease in patients with unstable angina compared with stable angina. Circulation 2002; 105: 2367–72.

    Article  PubMed  Google Scholar 

  7. Naunheim KS, Fiore AC, Fagan DC, McBride LR, Barner HB, Pennington DG, et al. Emergency coronary artery bypass grafting for failed angioplasty: Risk factors and outcome. Ann Thorac Surg 1989; 47: 816–23.

    Article  PubMed  CAS  Google Scholar 

  8. Lazar HL, Haan CK. Determinants of myocardial infarction following emergency coronary artery bypass for failed percutaneous coronary angioplasty. Ann Thorac Surg 1987; 44: 646–50.

    Article  PubMed  CAS  Google Scholar 

  9. Parsonnet V, Fisch D, Gielchinsky I, Hochberg M, Hussain SM, Karanam R, et al. Emergency operation after failed angioplasty. J Thorac Cardiovasc Surg 1988; 96: 198–203.

    PubMed  CAS  Google Scholar 

  10. Greene MA, Gray LA Jr, Slater AD, Ganzel BL, Mavroudis C. Emergency aortocoronary bypass after failed angioplasty. Ann Thorac Surg 1991; 51: 194–9.

    Article  PubMed  CAS  Google Scholar 

  11. Torchiana DF, Hirsch G, Buckley MJ, Hahn C, Allyn JW, Akins CW, et al. Intraaortic balloon pumping for cardiac support: Trends in practice and outcome, 1968 to 1995. J Thorac Cardiovasc Surg 1997; 113: 758–69.

    Article  PubMed  CAS  Google Scholar 

  12. Kaul TK, Fields BL, Riggins SL, Dacumos GC, Wyatt DA, Jones CR. Coronary artery bypass grafting within 30 days of an acute myocardial infarction. Ann Thorac Surg 1995; 59: 1169–76.

    Article  PubMed  CAS  Google Scholar 

  13. Creswell LL, Moulton MJ, Cox JL, Rosenbloom M. Revascularization after acute myocardial infarction. Ann Thorac Surg 1995; 60: 19–26.

    PubMed  CAS  Google Scholar 

  14. Kambara H. Myocardial reperfusion: Beneficial or harmful? Jpn Circ J 1988; 52: 715–7.

    PubMed  CAS  Google Scholar 

  15. Reimer KA, Jennings RB. Myocardial ischemia, hypoxia, and infarction. In: Fozzard Haeds, ed. The Heart and Cardiovascular System. New York: Raven Press, 1992; 1911–41.

    Google Scholar 

  16. Lichtenstein SV, Ashe KA, el Dalati H, Cusimano RJ, Panos A, Slutsky AS. Warm heart surgery. J Thorac Cardiovasc Surg 1991; 101: 269–74.

    PubMed  CAS  Google Scholar 

  17. Lichtenstein SV, Abel JG, Slutsky AS. Warm retrograde cardioplegia. Protection of the right ventricle in mitral valve operations. J Thorac Cardiovasc Surg 1992; 104: 374–80.

    PubMed  CAS  Google Scholar 

  18. Serruys PW, Unger F, Sousa JE, Jatene A, Bonnier HJ, Schonberger JP, et al. Comparison of coronary-artery bypass surgery and stenting for the treatment of multivessel disease. N Engl J Med 2001; 344: 1117–24.

    Article  PubMed  CAS  Google Scholar 

  19. Brener SJ, Lytle BW, Casserly IP, Schneider JP, Topol EJ, Lauer MS. Propensity analysis of long-term survival after surgical or percutaneous revascularization in patients with multivessel coronary artery disease and high-risk features. Circulation 2004; 109: 2290–5.

    Article  PubMed  Google Scholar 

  20. Hart JC, Spooner TH, Pym J, Flavin TF, Edgerton JR, Mack MJ, et al. A review of 1,582 consecutive Octopus off-pump coronary bypass patients. Ann Thorac Surg 2000; 70: 1017–20.

    Article  PubMed  CAS  Google Scholar 

  21. Mohr R, Moshkovitch Y, Shapira I, Amir G, Hod H, Gurevitch J. Coronary artery bypass without cardio-pulmonary bypass for patients with acute myocardial infarction. J Thorac Cardiovasc Surg 1999; 118: 50–6.

    Article  PubMed  CAS  Google Scholar 

  22. Sabik JF, Gillinov AM, Blackstone EH, Vacha C, Houghtaling PL, Navia J, et al. Does off-pump coronary surgery reduce morbidity and mortality? J Thorac Cardiovasc Surg 2002; 124: 698–707.

    Article  PubMed  Google Scholar 

  23. Mack M, Bachand D, Acuff T, Edgerton J, Prince S, Dewey T, et al. Improved outcomes in coronary artery bypass grafting with beating-heart techniques. J Thorac Cardiovasc Surg 2002; 124: 598–607.

    Article  PubMed  Google Scholar 

  24. Al-Ruzzeh S, Ambler G, Asimakopoulos G, Omar RZ, Hasan R, Fabri B, et al. Off-Pump Coronary Artery Bypass (OPCAB) surgery reduces risk-stratified morbidity and mortality: A United Kingdom Multi-Center Comparative Analysis of Early Clinical Outcome. Circulation 2003; 108 (Suppl I): 1–8.

    Google Scholar 

  25. Khan NE, De Souza A, Mister R, Flather M, Clague J, Davies S, et al. A randomized comparison of off-pump and on-pump multivessel coronary-artery bypass surgery. N Engl J Med 2004; 350: 21–8.

    Article  PubMed  CAS  Google Scholar 

  26. Puskas JD, Williams WH, Mahoney EM, Huber PR, Block PC, Duke PG, et al. Off-pump vs. conventional coronary artery bypass grafting: Early and 1-year graft patency, cost, and quality-of-life outcomes: A randomized trial. JAMA 2004; 291: 1841–9.

    Article  PubMed  CAS  Google Scholar 

  27. Williams ML, Muhlbaier LH, Schroder JN, Hata JA, Peterson ED, Smith PK, et al. Risk-adjusted short- and long-term outcomes for on-pump versus off-pump coronary artery bypass surgery. Circulation 2005; 112 (9 Suppl): 366–70.

    Google Scholar 

  28. Ohteki H, Itoh T, Natsuaki M, Minato N, Suda H. Intraoperative ultrasonic imaging of the ascending aorta in ischemic heart disease. Ann Thorac Surg 1990; 50: 539–42.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Tenjin-kai Shin-Koga Hospital, 120 Tenjin-cho, 830-0033, Kurume, Fukuoka, Japan

    Keiji Kamohara MD, Masaru Yoshikai MD, Junji Yunoki MD, Hideyuki Fumoto MD & Masakatsu Hamada MD

  2. Department of Thoracic and Cardiovascular Surgery, Saga Medical School, Saga, Japan

    Junichi Murayama MD & Tsuyoshi Itoh MD

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  1. Keiji Kamohara MD
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  2. Masaru Yoshikai MD
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  3. Junji Yunoki MD
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  4. Hideyuki Fumoto MD
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  5. Masakatsu Hamada MD
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  7. Tsuyoshi Itoh MD
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Kamohara, K., Yoshikai, M., Yunoki, J. et al. Surgical revascularization for acute coronary syndrome. Jpn J Thorac Caridovasc Surg 54, 95–102 (2006). https://doi.org/10.1007/BF02744870

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  • DOI: https://doi.org/10.1007/BF02744870

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