Emergency Coronary Artery Bypass Grafting: Indications and Outcomes from 2003 through 2013

Abstract

Emergency coronary artery bypass grafting (CABG) is associated with increased in-hospital mortality rates and adverse events. This study retrospectively evaluated indications and outcomes in patients who underwent emergency CABG. The Society of Thoracic Surgeons database for a single center (Jewish Hospital) was queried to identify patients undergoing isolated CABG. Univariate analysis was performed. From January 2003 through December 2013, 5,940 patients underwent CABG; 212 presented with emergency status. A high proportion of female patients (28.2%) underwent emergency surgery. Emergency CABG patients experienced high rates of intra-aortic balloon pump support, bleeding, dialysis, in-hospital death, and prolonged length of stay. The proportion of emergency coronary artery bypass grafting declined during years 2008–2013 compared with 2003–2007 (2.2% vs. 4.5%, P < 0.001), but the incidence of angiographic accident (5.3% vs. 29.2%) increased as an indication. Ongoing ischemia remains the most frequent indication for emergency CABG, yet the incidence of angiographic accident has greatly increased. In-hospital mortality rates and adverse events remain high. If we look specifically at emergency CABG cases arising from angiographic accident, we find that 14 (15%) of all 93 emergency CABG deaths occurred in that subset of patients. Efforts to improve outcomes should therefore be focused on this high-risk group.

Re‐exploration after off‐pump coronary artery bypass grafting: Incidence, risk factors, and impact of timing

“…In our cohort, the reported mortality was 13.6%. Emergency surgery and a higher Euroscore are well documented because of mortality after cardiac surgery 9,17 . One would expect this finding as these patients are generally sicker with unstable hemodynamics.…”

Role of emergency coronary artery bypass grafting in the era of percutaneous interventions

“…The optimal timing in more stable patients with indications for CABG is unclear, with some studies showing increased mortality when CABG was performed in the first 12 to 24 hours after acute myocardial infarction whereas recent studies favour early CABG with better outcomes. 13 Patients presenting within six hours after onset of symptoms should be operated emergently to maximize myocardial salvage. 14 The goal should be to completely revascularise within 12 hours of symptom onset.…”

Cost of coronary syndrome treated with percutaneous coronary intervention and 30‐day unplanned readmission in the United States

“…Second, periprocedural CABG appears to be a major contributor to increased cost as the cost on average increases by $42,825 compared to a PCI without a periprocedural adverse event. An American study of emergency CABG reported that between 2008 and 2013, 29.2% of emergency CABG procedures were because of an attempted PCI causing a coronary artery dissection resulting in hemodynamic instability, which had increased from 5.3% in the period between 2003 and 2007 22 . This may reflect the present era of PCI in more complex anatomy, such as heavily calcified lesions, chronic total occlusion, and/or extremely tortuous, and coronary perforations may occur as a result of guide wire advancement, balloon/stent advancement, balloon/stent inflation, over sizing, or ruptured balloon/stent, entry into a subintimal passage in the setting of a severe dissection, 23 and the use of debulking atherectomy techniques 16 .…”