Publication Date
6-1-2016
Journal
The Texas Heart Journal
DOI
10.14503/THIJ-14-4978
PMID
27303236
Publication Date(s)
June 2016
Language
English
PMCID
PMC4894699
PubMedCentral® Posted Date
6-1-2016
PubMedCentral® Full Text Version
Post-Print
Published Open-Access
yes
Keywords
Coronary artery bypass/statistics & numerical data/trends, emergency, hospital mortality, myocardial reperfusion injury, myocardial revascularization/trends, percutaneous coronary intervention/trends, retrospective studies, treatment outcome
Copyright
This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.
Abstract
Emergency coronary artery bypass grafting (CABG) is associated with increased in-hospital mortality rates and adverse events. This study retrospectively evaluated indications and outcomes in patients who underwent emergency CABG.
The Society of Thoracic Surgeons database for a single center (Jewish Hospital) was queried to identify patients undergoing isolated CABG. Univariate analysis was performed.
From January 2003 through December 2013, 5,940 patients underwent CABG; 212 presented with emergency status. A high proportion of female patients (28.2%) underwent emergency surgery. Emergency CABG patients experienced high rates of intra-aortic balloon pump support, bleeding, dialysis, in-hospital death, and prolonged length of stay. The proportion of emergency coronary artery bypass grafting declined during years 2008–2013 compared with 2003–2007 (2.2% vs. 4.5%, P < 0.001), but the incidence of angiographic accident (5.3% vs. 29.2%) increased as an indication.
Ongoing ischemia remains the most frequent indication for emergency CABG, yet the incidence of angiographic accident has greatly increased. In-hospital mortality rates and adverse events remain high. If we look specifically at emergency CABG cases arising from angiographic accident, we find that 14 (15%) of all 93 emergency CABG deaths occurred in that subset of patients. Efforts to improve outcomes should therefore be focused on this high-risk group.