Short- and Long-term Risk of Coronary Artery Bypass Graft Surgery in Acute Coronary Syndrome

Abstract

Background: Percutaneous coronary intervention is the revascularization procedure most widely used in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). However, coronary artery bypass graft surgery is a therapeuticalternative which allows treating these patients with a favorable outcome.Objectives: The aim of this study was to compare in-hospital and long-term outcome of patients undergoing coronary arterybypass graft surgery according to their clinical presentation.Methods: Between January 1998 and July 2013, 3604 consecutive patients underwent isolated coronary artery bypass graftsurgery. The population was divided in patients with NSTEACS (ACS Group, n = 2079) or with chronic stable angina (CSAGroup, n = 1525). Postoperative and at follow-up morbidity and mortality were analyzed.Results: The CSA group had greater use of double mammary artery (58.2% vs. 50.3%; p = 0.001) and longer operative time(211 min vs. 203 min; p = 0.002). The ACS Group presented lower postoperative cardiac output (4.5% vs. 3.1%; p = 0.043) andhigher in-hospital mortality (2.8% vs. 1.8%; p = 0.046). After adjusting for risk score, there were no statistically significantdifferences in in-hospital mortality (1.3% in CSA vs. 1.6% in ACS; p = 0.681) or in the rate of postoperative complicationsbetween the two groups. Overall long-term survival at 10 years was not different between groups (CSA 85% ± 1.3% vs. ACS83% ± 1.1%; p = 0.363). The time-related freedom from reintervention was similar for both groups (CSA 89.5% ± 1.2% vs.ACS 89.1% ± 0.9%; p = 0.1680). These results did not change after adjusting for risk score.Conclusions: Patients with NSTEACS submitted to coronary artery bypass graft surgery presented greater perioperativemortality, but a long-term outcome similar to patients undergoing elective surgery. No difference in perioperative mortalitywas found between both groups after adjusting for risk score.