Emergency and Salvage Coronary Artery Bypass Grafting: Surgical Techniques, Outcomes, and Predictors of In-Hospital Mortality

Background: Emergency and salvage coronary artery bypass grafting (CABG) is a high-risk procedure often performed on critically ill patients where percutaneous coronary intervention is unsuitable or has been unsuccessful. Despite advancements in surgical techniques, the optimal approach between on-pump CABG (ONCAB) and off-pump CABG (OPCAB) in these settings remains debated, particularly concerning their impact on in-hospital mortality and long-term outcomes. This study aimed to compare the effects of ONCAB and OPCAB on in-hospital outcomes and long-term survival of patients undergoing emergency and salvage CABG and determine the predictors of in-hospital mortality for this high-risk cohort of patients. Method: A retrospective analysis was conducted on data from 459 patients who underwent emergency or salvage CABG between January 1996 and September 2023. Of these, 246 underwent ONCAB, and 213 underwent OPCAB. Propensity score matching (PSM) was applied to create a balanced cohort of 181 patients in each group, adjusting for preoperative characteristics. Univariate and multivariate logistic regression analyses were performed to identify predictors of in-hospital mortality, and Kaplan–Meier survival curves were generated to assess long-term survival. Results: In the matched cohort, in-hospital mortality was 11.6% for ONCAB and 6.6% for OPCAB (p = 0.100). Independent predictors of in-hospital mortality included advanced age (p = 0.042), high New York Heart Association classification (p = 0.002), diabetes (p = 0.042), and salvage procedures (p < 0.001). OPCAB was not independently associated with in-hospital mortality (p = 0.189). Long-term survival at 20 years was similar between ONCAB and OPCAB (p = 0.6263). Conclusions: Despite a relatively high in-hospital mortality, emergency and salvage CABG patients have acceptable short-term outcomes and long-term survival. The choice of surgical strategy does not impact outcomes. Emergency and salvage CABG remains viable and should be offered to suitable candidates.