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. 2016 Jun 1;43(3):214-9.
doi: 10.14503/THIJ-14-4978. eCollection 2016 Jun.

Emergency Coronary Artery Bypass Grafting: Indications and Outcomes from 2003 through 2013

Erin M Schumer, John H Chaney, Jaimin R Trivedi, Paul L Linsky, Matthew L Williams, Mark S Slaughter

Emergency Coronary Artery Bypass Grafting: Indications and Outcomes from 2003 through 2013

Erin M Schumer et al. Tex Heart Inst J. .

Abstract

Emergency coronary artery bypass grafting (CABG) is associated with increased in-hospital mortality rates and adverse events. This study retrospectively evaluated indications and outcomes in patients who underwent emergency CABG. The Society of Thoracic Surgeons database for a single center (Jewish Hospital) was queried to identify patients undergoing isolated CABG. Univariate analysis was performed. From January 2003 through December 2013, 5,940 patients underwent CABG; 212 presented with emergency status. A high proportion of female patients (28.2%) underwent emergency surgery. Emergency CABG patients experienced high rates of intra-aortic balloon pump support, bleeding, dialysis, in-hospital death, and prolonged length of stay. The proportion of emergency coronary artery bypass grafting declined during years 2008-2013 compared with 2003-2007 (2.2% vs. 4.5%, P < 0.001), but the incidence of angiographic accident (5.3% vs. 29.2%) increased as an indication. Ongoing ischemia remains the most frequent indication for emergency CABG, yet the incidence of angiographic accident has greatly increased. In-hospital mortality rates and adverse events remain high. If we look specifically at emergency CABG cases arising from angiographic accident, we find that 14 (15%) of all 93 emergency CABG deaths occurred in that subset of patients. Efforts to improve outcomes should therefore be focused on this high-risk group.

Keywords: Coronary artery bypass/statistics & numerical data/trends; emergency; hospital mortality; myocardial reperfusion injury; myocardial revascularization/trends; percutaneous coronary intervention/trends; retrospective studies; treatment outcome.

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Figures

Fig. 1
Fig. 1
Graph shows the number of coronary artery bypass grafting procedures performed at our institution annually from 2003 through 2013, stratified by nonemergency and emergency status.
Fig. 2
Fig. 2
Pie charts show indications for emergency coronary artery bypass grafting stratified by time period 2003–2007 versus time period 2008–2013. A) In 2003–2007, angiographic accidents accounted for 5.3% of emergency operations. B) In 2008–2013, this percentage increased dramatically to 29.2%. MI = myocardial infarction
See this image and copyright information in PMC

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