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

Mariano Camporrotondo, Juan Espinoza, Juan Pablo Costabel, Mariano Vrancic, Fernando Piccinini, Juan Camou, Solange Bonazzi, Bernardo Lupiañez, Mariano Benzadon, Daniel Navia


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.

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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020