Article Abstract

Early surgical myocardial revascularization in non-ST-segment elevation acute coronary syndrome

Authors: Sebastian V. Rojas, Mai Linh Trinh-Adams, Aitor Uribarri, Felix Fleissner, Pavel Iablonskii, Sara Rojas-Hernandez, Marcel Ricklefs, Andreas Martens, Stefan Rümke, Gregor Warnecke, Serghei Cebotari, Axel Haverich, Issam Ismail


Background: In non-ST-elevation myocardial infarction (NSTEMI) there is no consensus regarding optimal time point for coronary artery bypass grafting (CABG). Recent findings suggest that long-term outcomes are improved in early-revascularized NSTEMI patients. However, it has been stated that early surgery is associated to increased operative risk. In this study, we wanted to elucidate if early CABG in non-ST-elevation acute coronary syndrome can be performed safely.
Methods: We performed a monocentric-prospective observational study within a 2-year interval. A total of 217 consecutive patients (41 female, age 68.9±10.2, ES II 6.62±8.56) developed NSTEMI and underwent CABG. Patients were divided into two groups according to the time point of coronary artery bypass after symptom onset (group A: <72 h; group B: >72 h). Endpoints included 6-month mortality and incidence of MACE (death, stroke or re-infarction).
Results: There were no differences regarding mortality between both groups (30 days: group A 2.4% vs. group B 3.7%; P=0.592; 6 months: 8.4% vs. 6.0%; P=0.487). Incidence of MACE in the 6-month follow-up was also similar in both groups (group A: 9.6% vs. 9.7%, P=0.982). Regression analysis revealed as independent risk factors for mortality in the entire cohort ES II OR 1.045 (95% CI: 1.004–1.088). ES II remained an independent prognostic factor in group A OR 1.043 (95% CI: 1.003–1.086) and group B OR 1.032 (95% CI: 1.001–1.063).
Conclusions: Early revascularized patients showed a higher level of illness. However, results of early CABG were comparable to those following delayed revascularization. Moreover, EuroSCORE II was determined as independent risk factors for mortality.