Outcomes of coronary artery bypass grafting in patients with high-risk non-ST-segment elevation acute coronary syndrome within the first 24 hours of admission

Abstract

Aim. The current myocardial re-vascularisation guidelines recommend that the coronary re-vascularisation of patients with high-risk non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) should be performed within 24 hours of admission. In real clinical practice; however, it is not always possible to keep coronary bypass surgery on schedule owing to various reasons. The aim of the current study, which presents cases of successful adherence to the surgical schedule, was to explore the need for 24/7 cardiac surgery services and to evaluate the outcomes of early (i.e. during the first 24 hours) coronary artery bypass grafting in 21 patients with high-risk NSTE-ACSs.Methods. The medical records of patients undergone coronary bypass surgery for high-risk NSTE-ACSs within the first 24 hours of admission between 2017 and 2019 were retrospectively analysed.Results. The mean age of the patients was 64.3 ± 5.6 years. Myocardial infarction was confirmed in 52.4 % (n = 11) of the subjects and progressive angina pectoris in 47.6 % (n = 10). The average waiting time to surgery was 17.8 ± 4.7 hours. Besides, 9.5 % (n = 2) of the cases, who had received dual antiplatelet therapy, exhibited a shorter waiting time to surgery. Patients were characterised by extremely severe clinical and angiographic status as follows: one in three had post-infarction cardiosclerosis and a first-degree family history of obesity; one in four had a history of percutaneous coronary intervention; and 61.9 % (n = 13) were found to have a left main coronary artery lesion, in 79.6 % (n = 10) of whom the left main coronary artery stenosis appeared to be greater than 80 %, necessitating the intra-aortic balloon counter-pulsation therapy in 33.3 % (n = 7) overall. Also, the mean cardiopulmonary bypass time turned out to be 88.6 ± 27.1 minutes, with an aortic clamping time of 47.6 ± 14.7 minutes. The in-hospital mortality rate was 14.3 % (n = 3), with cardiac and respiratory failure as well as mediastinitis (in one patient) being among the causes of adverse outcomes. So far, none of the studied cases has required re-sternotomy due to bleeding or perioperative acute cerebrovascular accident.Conclusion. In high-risk NSTE-ACS patients with severe clinical and angiographic status, emergency coronary bypass surgery performed within 24 hours of admission may prove an effective treatment option that can help save patients’ lives through complete re-vascularisation.Received 31 March 2020. Revised 2 May2020. Accepted 16 May 2020. Funding: The study is supported as a part of the research program "Complete myocardial revascularization in patients with non-ST segment elevation acute coronary syndrome with coronary artery bypass grafting". Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and design: A.B. NishonovData collection and analysis: A.B. NishonovDrafting the article: A.B. Nishonov, R.S. TarasovCritical revision of the article: S.V. Ivanov, T.S. Golovina, L.S. BarbarashFinal approval of the version to be published: A.B. Nishonov, R.S. Tarasov, S.V. Ivanov, T.S. Golovina, L.S. Barbarash