Results of Isolated Emergency Coronary Bypass Surgery According to Acute Coronary Syndrome

Yıl 2019, Cilt: 22 Sayı: 1, 30 - 36, 11.04.2019

Mustafa Aldağ , Bahar Temur Cemal Kocaaslan Göktürk İpek Mahmut Yargı Tolga Can Ufuk Çiloğlu Şebnem Albeyoğlu Ergin Emin Eren

Öz

Introduction: The aim of the present study was to evaluate the results of isolated emergency coronary artery
bypass grafting (CABG) according to acute coronary syndrome (ACS) types in a single center with 5-year
experience.

Patients and Methods: A total of 138 patients who underwent emergency isolated CABG surgery from
September 2009 to July 2014 in our hospital were enrolled in this retrospective descriptive study. The cohort
was divided into four groups according to the type of ACS: (1) unstable angina (USAP) (n= 14, 10.1%), (2) nonST segment elevated myocardial infarction (NSTEMI) (n= 43, 31.2%), (3) ST segment elevated myocardial
infarction (STEMI) (n= 65, 47.1%), and (4) cardiogenic shock (SHOCK) (n= 16, 11.6%). There were three coprimary outcomes in the study: (1) in-hospital and 30-day mortality rate results, (2) mortality analysis according
to subgroups, and (3) to assess the performance of European System for Cardiac Operative Risk Evaluation
(EuroScore) II in patients with ACS who underwent emergency isolated CABG.

Results: No significant differences were observed between the groups with regard to demographic and
preoperative risk factors. The observed 30-day total mortality rate was 15.9% (n= 22). Mortality rates in the
subgroups were 7% (n= 1) in USAP, 4.65% (n= 2) in NSTEMI, 15.38% (n= 10) in STEMI, and 68.75% (n=
11) in SHOCK, respectively. There was a significant difference in mortality between the groups (p< 0.05). The
receiver operating characteristic curve value of EuroScore II was 0.890 (95% Confidence Interval, 0.826-0.937).

Conclusion: The current study demonstrates that the observed mortality rate for STEMI and SHOCK patients
requiring emergency CABG remains high. Moreover, EuroScore II has a good risk prediction in NSTEMI
patients while significantly underestimates the mortality in the other groups.

Anahtar Kelimeler

Acute coronary syndrome, coronary artery bypass grafting, emergency surgery, outcome, EuroScore II

Kaynakça

• 1. Solodky A, Behar S, Boyko V, Battler A, Hasdai D. The outcome of coronary artery bypass grafting surgery among patients hospitalized with acute coronary syndrome: the Euro Heart Survey of acute coronary syndrome experience. Cardiology 2005;103:44-7.
• 2. Maganti M, Brister SJ, Yau TM, Collins S, Badiwala M, Rao V. Changing trends in emergency coronary bypass surgery. J Thorac Cardiovasc Surg 2011;142:816-22.
• 3. Ferraris VA, Ferraris SP. Risk stratification and comorbidity. In: Cohn LH, Edmuns Jr, editors. Cardiac surgery in the adult. 2nd ed. New York: McGraw-Hill; 2003. p.187-224.
• 4. Au WK, Sun MP, Lam KT, Cheng LC, Chiu SW, Das SR. Mortality prediction in adult cardiac surgery patients: Comparison of two risk stratification models. Hong Kong Med J 2007;13:293-7.
• 5. Nashef SA, Roques F, Sharples LD, Nilsson J, Smith C, Goldstone AR, et al. EuroSCORE II. Eur J Cardiothorac Surg 2012;41:734-44.
• 6. 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011;124:2610-42.
• 7. Pilarczyk K, Boening A, Jakob H, Langebartels G, Markewitz A, Haake N, et al. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials. Eur J Cardiothorac Surg 2016;49:5-17.
• 8. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Rev Esp Cardiol (Engl Ed) 2017;70:1082.
• 9. Coumbe A, John R, Agirbasli M, McFalls E. Variation of mortality after coronary artery bypass surgery in relation to hour, day and month of the procedure. BMC Cardiovasc Disord 2011;11:63.
• 10. Khaladj N, Bobylev D, Peters S, Guenther S. Immediate surgical coronary revascularisation in patients presenting with acute myocardial infarction. J Cardiothorac Surg 2013;8:167.
• 11. Danner Bernhard C, Didilis V, Stojanovic T, Popov A. A three-group model to predict mortality in emergent coronary artery bypass graft surgery. Ann Thorac Surg 2009;88:1433-9.
• 12. Constance K, O’Brien S, Edwards F, Peterson E, Ferguson B. Trends in emergency coronary artery bypass grafting after percutaneous coronary intervention. Ann Thorac Surg 2006;81:1658-65.
• 13. White H, Assman S, Sanborn T, Jacobs A, Webb J, Sleeper LA, et al. Comparison of percutaneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock. Circulation 2005;112:1992-2001.
• 14. Yang EH, Gumina RJ, Lennon RJ, Holmes DR Jr, Rihal CS, Singh M. Emergency coronary artery bypass surgery for percutaneous coronary interventions: changesin the incidence, clinical characteristics, and indications from 1979 to 2003. J Am Coll Cardiol 20056;46:2004-9.
• 15. Kunt AG, Kurtcephe M, Hidiroglu M, Cetin L, Kucuker A, Bakuy V, et al. Comparison of original EuroSCORE, EuroSCORE II and STS risk models in a Turkish cardiac surgical cohort. Interact CardioVasc Thorac Surg 2013;16:625-9.
• 16. Barili F, Pacini D, Rosato F, Parolari A. The role of surgical procedures on discriminative performance of the updated EuroScore II. J Thorac Cardiovasc Surg 2013;146:986-7.
• 17. Grant SW, Hickey GL, Dimarakis I, Cooper G, Jenkins DP, Uppal R, et al. Performance of the EuroScore models in emergency cardiac surgery. Circ cardiovasc Qual Outcomes 2013;6:178-85.
• 18. Slottosch I, Liakopoulos O, Scherner M, Kuhn E, Deppe AC, Wacker M, et al. Preoperative intraaortic balloon pump before urgent coronary bypass grafting. Asian Cardiovasc Thorac Ann 2018;26:353-60.