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Article Type

Original Study

Abstract

Background The effect of surgical treatment on patients with acute coronary syndrome (ACS) is disputable. The objective of the present study was to analyze the outcome, in-hospital mortality, and its predictors as well as major adverse cardiac and cerebrovascular events in patients referred to coronary artery bypass grafting (CABG) with ACS presentation. Patients and methods Hospital medical records of ACS presentation were retrieved from Madinah Cardiac Center database between November 2011 and August 2017. A total number of 630 patients who underwent primary isolated CABG for ACS presentation were identified. Of these, unstable angina (UA) pectoris was present in 277 patients (group I), 253 patients (group II) had non-ST-elevation infarction, whereas 100 patients (group III) had ST-elevation infarction. All preoperative, intraoperative, and postoperative data were analyzed. In-hospital mortality and its predictors were determined. Results Overall in-hospital mortality was 6.5% (n = 41), being 4% in UA (n = 11), 8.7% in non-ST elevation myocardial infarction (NSTEMI) (n = 22), and 8% (n = 8) in ST elevation myocardial infarction. Mortality was significantly higher only in NSTEMI compared with UA (P = 0.05). Although cardiac causes of death were significantly higher in ST elevation myocardial infarction compared with UA (P = 0.04), noncardiac causes were significantly higher in NSTEMI compared with UA (P = 0.04). Logistic regression analyses identified age more than 65 years, New York Heart Functional Association 3, ejection fraction less than 45%, and Logistic EuroSCORE more than 10 as significant predictors of in-hospital mortality. Conclusion Primary isolated on-pump CABG can be performed in patients with ACS presentation as a revascularization option with acceptable clinical results. However, clinical outcome differs among different groups of ACS. Therefore an individual risk stratification of each patient in ACS is necessary.

Keywords

Acute coronary syndrome, coronary artery bypass, mortality, outcome, predictors

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