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Surgical revascularization and perioperative management in patients with non-ST-elevation acute coronary syndromes.
Rocz Akad Med Bialymst 2005; 50:37-44RA

Abstract

PURPOSE

The management and surgical revascularization treatment of patients with acute coronary syndromes (ACS) have undergone great evolution over the past decade. The objective of the present study was therefore to analyze the outcome and predictors of survival in patients unresponsive to maximal non-surgical treatment referred to emergency coronary artery bypass grafting (CABG) with ACS.

MATERIAL AND METHODS

Between October 1999 and September 2004, a total of 3571 CABG patients underwent primary isolated CABG at our institution. Out of these, non-ACS (N-ACS) was present in 3124 patients (group 1), 386 patients (group 2) had non-ST-elevation ACS (NSTE-ACS), whereas 61 patients (group 3) had ST-elevation ACS (STE-ACS). Clinical data, in-hospital morbidity and mortality were prospectively recorded and studied retrospectively in the groups.

RESULTS

Left main stem stenosis was observed in 25%, 32%, and 41%, respectively (P<0.02). Previous myocardial infarction was found in 33%, 43%, and 73% (P<0.001). Overall in-hospital mortality was 1.5% in group 1, 4.2% in group 2, and 13.0% in group 3 (P< 0.001). Logistic regression and receiver operating characteristic analyses identified cTnI as the strongest preoperative predictor significantly related to in-hospital mortality. A preoperative cTnI level above 1.5 ng/ml was the best single predictor for in-hospital mortality amongst patients with ACS.

CONCLUSIONS

The present study clearly demonstrates a significant difference of in-hospital morbidity and mortality between patients with ACS undergoing CABG. A more precise patient's risk stratification on admission and improvements in the perioperative management with adjunctive pharmacological therapies and the use of intraaortic balloon counter pulsation may improve patients' outcome.

Authors+Show Affiliations

Department of Thoracic and Cardiovascular Surgery, West-German Heart Center Essen, University Clinic of Essen, Germany. matthias.thielmann@uni-essen.deNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16358937

Citation

Thielmann, M, and H Jakob. "Surgical Revascularization and Perioperative Management in Patients With non-ST-elevation Acute Coronary Syndromes." Roczniki Akademii Medycznej W Bialymstoku (1995), vol. 50, 2005, pp. 37-44.
Thielmann M, Jakob H. Surgical revascularization and perioperative management in patients with non-ST-elevation acute coronary syndromes. Rocz Akad Med Bialymst. 2005;50:37-44.
Thielmann, M., & Jakob, H. (2005). Surgical revascularization and perioperative management in patients with non-ST-elevation acute coronary syndromes. Roczniki Akademii Medycznej W Bialymstoku (1995), 50, pp. 37-44.
Thielmann M, Jakob H. Surgical Revascularization and Perioperative Management in Patients With non-ST-elevation Acute Coronary Syndromes. Rocz Akad Med Bialymst. 2005;50:37-44. PubMed PMID: 16358937.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical revascularization and perioperative management in patients with non-ST-elevation acute coronary syndromes. AU - Thielmann,M, AU - Jakob,H, PY - 2005/12/20/pubmed PY - 2006/2/1/medline PY - 2005/12/20/entrez SP - 37 EP - 44 JF - Roczniki Akademii Medycznej w Bialymstoku (1995) JO - Rocz. Akad. Med. Bialymst. VL - 50 N2 - PURPOSE: The management and surgical revascularization treatment of patients with acute coronary syndromes (ACS) have undergone great evolution over the past decade. The objective of the present study was therefore to analyze the outcome and predictors of survival in patients unresponsive to maximal non-surgical treatment referred to emergency coronary artery bypass grafting (CABG) with ACS. MATERIAL AND METHODS: Between October 1999 and September 2004, a total of 3571 CABG patients underwent primary isolated CABG at our institution. Out of these, non-ACS (N-ACS) was present in 3124 patients (group 1), 386 patients (group 2) had non-ST-elevation ACS (NSTE-ACS), whereas 61 patients (group 3) had ST-elevation ACS (STE-ACS). Clinical data, in-hospital morbidity and mortality were prospectively recorded and studied retrospectively in the groups. RESULTS: Left main stem stenosis was observed in 25%, 32%, and 41%, respectively (P<0.02). Previous myocardial infarction was found in 33%, 43%, and 73% (P<0.001). Overall in-hospital mortality was 1.5% in group 1, 4.2% in group 2, and 13.0% in group 3 (P< 0.001). Logistic regression and receiver operating characteristic analyses identified cTnI as the strongest preoperative predictor significantly related to in-hospital mortality. A preoperative cTnI level above 1.5 ng/ml was the best single predictor for in-hospital mortality amongst patients with ACS. CONCLUSIONS: The present study clearly demonstrates a significant difference of in-hospital morbidity and mortality between patients with ACS undergoing CABG. A more precise patient's risk stratification on admission and improvements in the perioperative management with adjunctive pharmacological therapies and the use of intraaortic balloon counter pulsation may improve patients' outcome. UR - https://www.unboundmedicine.com/medline/citation/16358937/Surgical_revascularization_and_perioperative_management_in_patients_with_non_ST_elevation_acute_coronary_syndromes_ L2 - https://medlineplus.gov/heartattack.html DB - PRIME DP - Unbound Medicine ER -