Predictors of short-term mortality in patients undergoing emergency coronary artery bypass grafting: a systematic review and meta-analysis

Aim: Emergency coronary artery bypass grafting (CABG) is a critical intervention for patients with acute coronary syndrome (ACS), particularly in high-risk cases where rapid revascularization is necessary. Despite advancements in surgical techniques, early mortality rates remain high. This study aims to identify predictors of short-term mortality in patients undergoing emergency CABG for ACS through a comprehensive systematic review and meta-analysis. Methods: A PRISMA-based systematic review was performed using major databases up to May 2024. Inclusion criteria focused on studies reporting short-term mortality outcomes and associated predictors in patients undergoing emergency CABG for ACS. Data extraction and quality assessment were performed independently by multiple reviewers. Statistical analysis included pooled odds ratios (OR) and confidence intervals (CI) for identified predictors using random-effects models. Results: A total of 20 studies encompassing 4,777 patients met the inclusion criteria. Key predictors of short-term mortality include advanced age (OR 1.40, 95%CI: 1.07-1.82), cardiogenic shock (OR 5.35, 95%CI: 3.27-8.74), chronic kidney disease (OR 3.55, 95%CI: 1.30-9.71), and preoperative use of an intra-aortic balloon pump (OR 2.46, 95%CI: 1.00-6.04). Timing of surgery within the first 48 h post-ACS was also associated with higher mortality rates. Conclusion: This systematic review and meta-analysis highlight important predictors of short-term mortality in patients undergoing emergency CABG for ACS. These findings underscore the importance of tailored perioperative management strategies to improve outcomes in this high-risk patient population.