Optimal timing for surgical revascularization in survivors of acute coronary syndromes eligible for elective coronary artery bypass graft surgery

Abstract

BackgroundSeveral patients with acute coronary syndrome (ACS) are discharged home after the acute phase of ACS and are suitable for elective coronary artery bypass graft (CABG) surgery. The aim of the study was to assess the optimal timing for surgical revascularization and its effect on 12-month outcome in patients discharged from hospital after ACS and referred for elective CABG surgery. MethodsThe analysis involved 2028 patients enrolled into the ongoing Polish Registry of Acute Coronary Syndromes (PL-ACS) who were discharged from hospital with the intention to undergo elective CABG surgery. ResultsAmong 2028 patients 1216 (60.0%) underwent surgery during 12months of follow-up. Patients who underwent surgical revascularization had a lower prevalence of mortality (5.7% vs 11.5%, p<0.0001). Patients who underwent surgery within the first month had a significantly higher prevalence of mortality than those who did not undergo surgery (5.7% vs 1.6%, p<0.0001). By the third month, the two cumulative mortalities were similar (4.2% vs 4.6%, p=0.65). From the beginning of the fourth month, the cumulative mortality was significantly higher among patients who did not undergo surgery. Conclusions1.Only half of the survivors from ACS eligible for CABG surgery after hospital discharge have the procedure within 6months.2.Patients eligible for surgery and who do not undergo surgery have a twofold higher mortality twice at 12months.3.Surgical revascularization done during the first month after ACS is associated with a higher prevalence of mortality. The delay of CABG surgery should probably not exceed 3months.