Abstract
Objectives: Coronary artery bypass grafting (CABG) has a favorable prognosis when scheduled; however, the postoperative outcomes in acute coronary syndrome (ACS) are poor. Whether or not patients requiring resuscitation should be transferred to the operating room remains unclear. We investigated the outcomes of patients who underwent emergency CABG, including salvage CABG.
Materials and methods: Of the 276 single CABG procedures performed at our hospital, 67 patients underwent emergency CABG (9 salvage and 58 non-salvage cases) for ACS, and 209 underwent elective CABG. We evaluated the preoperative factors and postoperative course, including all-cause mortality and major adverse cardiac and cerebrovascular events, as endpoints. Furthermore, the time required to establish mechanical circulatory support (MCS) to save salvage cases was investigated.
Results: Chronic kidney disease was significantly more prevalent in the salvage group than in the non-salvage group. In the salvage group, preoperative inotropic agents and use of cardiopulmonary bypass during CABG were more frequent (p < 0.0001 and p = 0.0009, respectively), the intensive-care unit stay longer (p = 0.0010), all-cause mortality higher (p = 0.0031), and major adverse cardiac and cerebrovascular events (MACCE) (p < 0.0001) than the non-salvage group. Furthermore, 2 patients (22%) died within 30 days after CABG, and there was difficulty in establishing MCS before CABG, while 4 patients (44%) died in the late phase. Troponin I level was an independent risk factor for long-term mortality, and hyperlipidemia and salvage CABG were independent risk factors for MACCE.
Conclusions: The prognosis of salvage CABG is very poor; however, 30-day (22%) and long-term (44%) mortalities are acceptable. Salvage CABG is not an independent risk factor for long-term mortality but is an independent risk factor for MACCE in patients after CABG for ACS. The establishment of MCS before circulatory collapse and prompt consultation with cardiac surgeons may improve the outcomes.
