Coronary revascularization in acute coronary syndrome: does the choice of the conduit matter?

Background: Our retrospective study evaluates the impact on short - and long-term outcome according to the graft selection during emergency coronary revascularization surgery.

Methods: Three hundred thirty-nine Patients with acute coronary syndrome undergoing emergency coronary bypass surgery at our institution from 2008 until 2018 were analyzed using propensity score analysis. The primary endpoint was in-hospital survival. Secondary endpoints were postoperative bleeding, contractile dysfunction, postoperative percutaneous coronary intervention, myocardial infarction and wound infection. Patients were divided in two groups according to the bypass grafts received (group 0 [N.=222]: combined arterial and venous grafts for the and group 1 [N.=117]: complete arterial revascularization).

Results: There is significant improvement of left ventricular function postoperatively in patients undergoing emergency coronary revascularization for acute myocardial infarction where arterial grafts were used. Furthermore, there is significant difference between postoperative cardiac enzymes with lower values in group 1 (creatine kinase myocardial band P=0.0001; Troponin T P=0.010). There was no significant difference in short and long-term survival between two groups. Five-years survival analysis between both groups did not show significant difference with Log-Rank test adjusted P value=0.49 (unadjusted P value=0.005). There was no significant difference in perioperative myocardial infarction, postoperative bleeding, and the need for postoperative coronary angiography.

Conclusions: Emergency coronary artery bypass grafting with arterial grafts shows significant improvement of left ventricular function postoperatively. However, utilization of bilateral internal mammary artery grafts in emergency coronary revascularization has no significant impact on short term or 5-year survival.