Emergency Coronary Artery Bypass Grafting: Clinical Analysis of 27 Consecutive Patients_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGChang-tian , XUBiao , ZHANGLei , HUANGHai-rong , CHENGXiao-feng , WUHai-wei ,  LIDe-min

Department of Thoracic and Cardiovascular Surgery, Nanjing General Hospital of Nanjing Command, Nanjing 210002, P. R. China;

Corresponding author：

LIDe-min, Email: dr.demin@126.com

Keywords：

Coronary heart disease; Coronary artery bypass grafting; Emergency; Clinical analysis

DOI：

10.7507/1007-4848.20160105

Video：

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Objective To evaluate the effects of emergency coronary artery bypass grafting (ECABG) in the treatment of emergent patients, and to summarize our experience. Methods We retrospectively analyzed the clinical data of 160 patients who underwent coronary artery bypass grafting (CABG) in Nanjing General Hospital of Nanjing Command from January 2010 through December 2013. The patients were divided into an ECABG group (operation underwent on the day diagnosed, n=27, 22 males and 5 females, at age of 70.2±10.2 years) and a conventional group (CABG operation underwent on 5 days after diagnosed, n=133, 104 males and 29 females, at age of 66.3±8.9 years). Results Statistical differences were found between the ECABG group and the conventional group in EuroSCORE (5.8±3.2 versus 3.4±2.1, P=0.001), acute myocardial infarction (33.3% vs. 11.3%, P=0.007), rate of application of IABP (29.6% versus 12.0%, P=0.034), pericardium and mediastinal tube drainage (533.4±132.8 ml versus 414.8±124.3 ml, P=0.018). There was no statistical difference in continuous renal replacement therapy (P=0.677), postoperative sternal wound complication (P=1.000), the length of hospital stay (P=0.589), or 30-day-mortality (P=0.198) between the two groups. We followed up 24 patients(88.89%) for 3-36 months in the ECABG group. One patient occurred angina symptoms at the end of 1 year follow-up. The symptoms disappeared after treatment. The other patients had no symptoms of angina pectoris and myocardial ischemia. Conclusion ECABG as a lifesaving therapy is an effective procedure in the treatment of severe and acute patients. Sufficient preoperative assessment, good myocardial protection, full revascularization, and comprehensive treatment plays an important role in the success of ECABG.

Citation： WANGChang-tian, XUBiao, ZHANGLei, HUANGHai-rong, CHENGXiao-feng, WUHai-wei, LIDe-min. Emergency Coronary Artery Bypass Grafting: Clinical Analysis of 27 Consecutive Patients. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(5): 444-448. doi: 10.7507/1007-4848.20160105 Copy

1.	Khaladj N, Bobylev D, Peterss S, et al. Immediate surgical coronary revascularisation in patients presenting with acute myocardial infarction. J Cardiothorac Surg, 2013, 8:167-174.
2.	肖苍松, 王嵘, 李伯君, 等. 急诊冠状动脉搭桥救治急性冠状动脉综合征及中期随访. 南方医科大学学报, 2014, 34(5):679-682.
3.	曹旭, 解强, 白雪涛, 等. 急诊冠状动脉旁路移植术的临床分析. 中国胸心血管外科临床杂志, 2011, 18(3):267-268.
4.	Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guide-line for coronary artery bypass graft surgery:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23):e652-e735.
5.	Comas GM, Esrig BC, Oz MC. Surgery for myocardial salvage in acute myocardial infarction and acute coronary syndromes. Heart Fail Clin, 2007, 3(2):181-210.
6.	White HD, Assmann SF, Sanborn TA, et al. Comparison of percu-taneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock:results from the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial. Circulation, 2005, 112(13):1992-2001.
7.	Sezai A, Hata M, Yoshitake I, et al. Results of emergency coronary artery bypass grafting for acute myocardial infarction:importance of intraoperative and postoperative cardiac medical therapy. Ann Thorac Cardiovasc Surg, 2012, 18(4):338-346.
8.	Weiss ES, Chang DD, Joyce DL, et al. Optimal timing of coronary artery bypass after acute myocardial infarction:a review of Califo-rnia discharge data. J Thorac Cardiovasc Surg, 2008, 135(3):503-511.
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11.	Fajadet J, Chieffo A. Current management of left main coronary artery disease. Eur Heart J, 2012, 33(1):36-50b.
12.	Fox K, Garcia MA, Ardissino D, et al. Guidelines on management of stable angina:executive summary. The task force on the management of stable angina pectoris of the European Society of Cardiology. Eur Heart J, 2006, 27(11):1341-1381.
13.	Patel MR, Dehmer GJ, Hirshfeld JW, et al. ACCF/SCAI/AATS//AHA/ASNC 2009 Appropriateness criteria for coronary revascu-larization. J Am Coll Cardiol, 2009, 53(6):530-553.
14.	Montalescot G, Brieger D, Eagle KA, et al. GRACE Investigators:Unprotected left main revascularization in patients with acute coronary syndromes. Eur Heart J, 2009, 30(19):2308-2317.
15.	Allen BS, Buckberg GD, Fontan FM, et al. Superiority of controlled surgical reperfusion versus percutaneous transluminal coronary angioplasty in acute coronary occlusion. J Thorac Cardiovasc Surg, 1993, 105(5):864-879.
16.	李德闽, 王常田, 申翼, 等. 非体外循环不停跳冠脉旁路移植治疗左主干重度狭窄临床分析. 江苏医药, 2013, 39(5):570-572.
17.	Caceres M, He X, Rankin JS, et al. Risk stratification and prognostic effects of internal thoracic artery grafting in acute myocardial infarction. J Thorac Cardiovasc Surg, 2013, 146(1):78-84.
18.	Goldberg RJ, Samad NA, Yarzebski J, et al. Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med, 1999, 340(15):1162-1168.
19.	丁文军, 魏强, 孙勇新, 等. 主动脉内球囊反搏在高危患者非体外循环冠状动脉旁路移植术中的应用. 中国胸心血管外科临床杂志, 2013, 20(1):10-14.
20.	Moon C. Preoperative intra-aortic balloon pumping in high-risk cardiac surgery patients. Dimens Crit Care Nurs, 2012, 31(4):223-227.
21.	郑泽, 柳景华, 黄方炯. 急诊冠状动脉旁路移植术前应用双联抗血小板药物对围术期出血的影响. 心肺血管病杂志, 2013, 32(5):553-556.
22.	黄晓华, 罗能贞, 胡大清. 冠状动脉旁路移植术后并发症及死亡原因分析. 中国胸心血管外科临床杂志, 2014, 21(1):122-124.
23.	Kolh P, Windecker S, Alfonso F, et al. 2014 ESC/EACTS guidelines on myocardial revascularization:The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg, 2014, 46(4):517-592.
24.	Caceres M, Weiman DS. Optimal timing of coronary artery bypass grafting in acute myocardial infarction. Ann Thorac Surg, 2013, 95(1):365-372.
25.	Rosenfeldt FL, Wilson MD, Buxton BF, et al. Coronary artery bypass surgery provides long-term results superior to percutaneous coronary intervention. Heart Lung Circ, 2012, 21(1):1-11.

1. Khaladj N, Bobylev D, Peterss S, et al. Immediate surgical coronary revascularisation in patients presenting with acute myocardial infarction. J Cardiothorac Surg, 2013, 8:167-174.
2. 肖苍松, 王嵘, 李伯君, 等. 急诊冠状动脉搭桥救治急性冠状动脉综合征及中期随访. 南方医科大学学报, 2014, 34(5):679-682.
3. 曹旭, 解强, 白雪涛, 等. 急诊冠状动脉旁路移植术的临床分析. 中国胸心血管外科临床杂志, 2011, 18(3):267-268.
4. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guide-line for coronary artery bypass graft surgery:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation, 2011, 124(23):e652-e735.
5. Comas GM, Esrig BC, Oz MC. Surgery for myocardial salvage in acute myocardial infarction and acute coronary syndromes. Heart Fail Clin, 2007, 3(2):181-210.
6. White HD, Assmann SF, Sanborn TA, et al. Comparison of percu-taneous coronary intervention and coronary artery bypass grafting after acute myocardial infarction complicated by cardiogenic shock:results from the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial. Circulation, 2005, 112(13):1992-2001.
7. Sezai A, Hata M, Yoshitake I, et al. Results of emergency coronary artery bypass grafting for acute myocardial infarction:importance of intraoperative and postoperative cardiac medical therapy. Ann Thorac Cardiovasc Surg, 2012, 18(4):338-346.
8. Weiss ES, Chang DD, Joyce DL, et al. Optimal timing of coronary artery bypass after acute myocardial infarction:a review of Califo-rnia discharge data. J Thorac Cardiovasc Surg, 2008, 135(3):503-511.
9. Thielmann M, Neuhäuser M, Marr A, et al. Predictors and outcomes of coronary artery bypass grafting in ST elevation myocardial infarction. Ann Thorac Surg, 2007, 84(1):17-24.
10. Lee DC, Oz MC, Weinberg AD, et al. Appropriate timing of surgical intervention after transmural acute myocardial infarction. J Thorac Cardiovasc Surg, 2003, 125(1):115-120.
11. Fajadet J, Chieffo A. Current management of left main coronary artery disease. Eur Heart J, 2012, 33(1):36-50b.
12. Fox K, Garcia MA, Ardissino D, et al. Guidelines on management of stable angina:executive summary. The task force on the management of stable angina pectoris of the European Society of Cardiology. Eur Heart J, 2006, 27(11):1341-1381.
13. Patel MR, Dehmer GJ, Hirshfeld JW, et al. ACCF/SCAI/AATS//AHA/ASNC 2009 Appropriateness criteria for coronary revascu-larization. J Am Coll Cardiol, 2009, 53(6):530-553.
14. Montalescot G, Brieger D, Eagle KA, et al. GRACE Investigators:Unprotected left main revascularization in patients with acute coronary syndromes. Eur Heart J, 2009, 30(19):2308-2317.
15. Allen BS, Buckberg GD, Fontan FM, et al. Superiority of controlled surgical reperfusion versus percutaneous transluminal coronary angioplasty in acute coronary occlusion. J Thorac Cardiovasc Surg, 1993, 105(5):864-879.
16. 李德闽, 王常田, 申翼, 等. 非体外循环不停跳冠脉旁路移植治疗左主干重度狭窄临床分析. 江苏医药, 2013, 39(5):570-572.
17. Caceres M, He X, Rankin JS, et al. Risk stratification and prognostic effects of internal thoracic artery grafting in acute myocardial infarction. J Thorac Cardiovasc Surg, 2013, 146(1):78-84.
18. Goldberg RJ, Samad NA, Yarzebski J, et al. Temporal trends in cardiogenic shock complicating acute myocardial infarction. N Engl J Med, 1999, 340(15):1162-1168.
19. 丁文军, 魏强, 孙勇新, 等. 主动脉内球囊反搏在高危患者非体外循环冠状动脉旁路移植术中的应用. 中国胸心血管外科临床杂志, 2013, 20(1):10-14.
20. Moon C. Preoperative intra-aortic balloon pumping in high-risk cardiac surgery patients. Dimens Crit Care Nurs, 2012, 31(4):223-227.
21. 郑泽, 柳景华, 黄方炯. 急诊冠状动脉旁路移植术前应用双联抗血小板药物对围术期出血的影响. 心肺血管病杂志, 2013, 32(5):553-556.
22. 黄晓华, 罗能贞, 胡大清. 冠状动脉旁路移植术后并发症及死亡原因分析. 中国胸心血管外科临床杂志, 2014, 21(1):122-124.
23. Kolh P, Windecker S, Alfonso F, et al. 2014 ESC/EACTS guidelines on myocardial revascularization:The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur J Cardiothorac Surg, 2014, 46(4):517-592.
24. Caceres M, Weiman DS. Optimal timing of coronary artery bypass grafting in acute myocardial infarction. Ann Thorac Surg, 2013, 95(1):365-372.
25. Rosenfeldt FL, Wilson MD, Buxton BF, et al. Coronary artery bypass surgery provides long-term results superior to percutaneous coronary intervention. Heart Lung Circ, 2012, 21(1):1-11.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Emergency Coronary Artery Bypass Grafting: Clinical Analysis of 27 Consecutive Patients

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