Optimal timing of coronary artery bypass grafting in patients with acute coronary syndrome

The OBJECTIVE was to determine the impact of timing of coronary artery bypass grafting in patients with acute coronary syndromes (ACS) on treatment outcomes, such as 30-day mortality and the incidence of perioperative complications.METHODS AND MATERIALS. Completed cases of treatment from 2014 to 2022 were analyzed among 264 patients (193 men and 71 women) (mean age 64.5±9.2 years) with various forms of ACS who underwent myocardial revascularization with coronary artery bypass grafting. Thirty-four patients presented with STEMI, 96 with NSTEMI, and 134 with unstable angina. Of these, 32 patients underwent emergency surgery (within 24 hours of symptom onset). Urgent surgery (more than 24 hours) was performed in 232 cases. The follow-up period was 30 days. The incidence of 30-day mortality among patients, as well as the incidence of perioperative complications such as acute myocardial infarction, stroke, and acute renal failure, were assessed.RESULTS. 30-day mortality and perioperative complications among patients undergoing emergency surgery were two or more times higher. However, no statistically significant difference in the odds of developing or in the incidence of death, postoperative acute renal failure, or stroke was found in either the overall cohort or among patients with different forms of ACS, even those as severe as those with STEMI (P>0.05). The risk of developing postoperative acute myocardial infarction was significantly higher in emergency surgeries (P<0.05).CONCLUSION. CABG is an option for patients with ACS who are not candidates for PCI. However, despite the absence of a statistically significant difference, there is a statistical trend indicating that performing surgery on an emergency basis is associated with an increased incidence of mortality and perioperative stroke and acute renal failure in patients with STEMI and unstable angina.