Urgent coronary artery bypasses grafting versus elective post-acute coronary artery syndrome

Abstract

Background:  Coronary artery bypass grafting (CABG) can be divided according to its timing into elective, urgent, emergency and salvage. Urgent CABG has a higher morbidity and mortality than elective CABG. Aim of work: to compare the early outcome of urgent coronary artery bypass grafting surgery post-acute coronary syndrome versus elective coronary artery bypass grafting surgery about early outcome and prognosis including early post-operative morbidity and mortality. Patients and Methods: 44 patients underwent coronary artery bypass grafting for acute coronary syndrome. Patients were divided into two groups according to the timing of surgery. The urgent group included 22 patients, and the elective group included 22 patients. The two groups were compared regarding preoperative, operative, and postoperative data.Results: Patients in the urgent CABG group had a higher frequency of smoking (p=0.049), higher number of patient with left main vessel disease and higher STS score for morbidity and mortality otherwise, all baseline characteristics were comparable between the two groups. All the operative data were comparable between the two groups except the usage of inotropic support was significantly higher in the urgent CABG group compared to the elective CABG group (p=0.03). Although both groups had a relatively similar survival rate (p= 0.664), urgent CABG patients were more liable to postoperative prolonged ICU stay (p=0.029) and hospital stay (p=0.029). Our analysis showed that preoperative higher frequency of smoking (p=0.049), use of inotropes (p=0.03) and prolonged ventilation time (p=0.011) were independent risk factors for mortality after urgent CABG. Conclusion: Patients undergoing urgent CABG have a significantly higher preoperative risk and a significantly worse early postoperative outcomes. Postoperative mortality is expected to be higher in the urgent CABG patients but without a statistically significant difference between them and the elective patients.