Emergency coronary artery bypass graft surgery for acute coronary syndrome : Beating heart versus conventional cardioplegic cardiac arrest strategies

• Published in: Circulation (New York, N.Y.) N.Y.), 2006-07, Vol.114 (1), p.I477-I485
• Main Authors: RASTAN, Ardawan Julian, ECKENSTEIN, Judith Isabell, HENTSCHEL, Bettina, FUNKAT, Anne Kathrin, GUMMERT, Jan Fritz, DOLL, Nicolas, WALTHER, Thomas, FALK, Volkmar, MOHR, Friedrich Wilhelm
• Format: Article
• Language: English
• Subjects: Adult; Aged; Angina, Unstable - complications; Angina, Unstable - surgery; Biological and medical sciences; Biomarkers; Blood and lymphatic vessels; Cardiology. Vascular system; Cohort Studies; Coronary Artery Bypass - methods; Coronary Artery Bypass - statistics & numerical data; Coronary Artery Bypass, Off-Pump - statistics & numerical data; Coronary Circulation; Coronary heart disease; Creatine Kinase, MB Form - blood; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Electrocardiography; Emergencies; Female; Follow-Up Studies; Heart; Heart Arrest, Induced - statistics & numerical data; Hemodynamics; Hospital Mortality; Humans; Internal Mammary-Coronary Artery Anastomosis - methods; Internal Mammary-Coronary Artery Anastomosis - statistics & numerical data; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - surgery; Myocardial Reperfusion Injury - blood; Myocardial Reperfusion Injury - prevention & control; Retrospective Studies; Shock, Cardiogenic - etiology; Shock, Cardiogenic - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.105.001545

Aim of this study was to compare the outcome of beating heart versus conventional coronary artery bypass graft (CABG) strategies in acute coronary syndromes for emergency indications. 638 consecutive patients with acute coronary syndrome (ACS) receiving emergency CABG surgery via midline sternotomy from January 2000 to September 2005 were evaluated. Propensity score analysis was used to predict the probability of undergoing beating heart (BH) (n=240) versus cardioplegic cardiac arrest (CA) (n=398) strategies. Patients presented with stable hemodynamics (n=531) or in cardiogenic shock (CS) (n=107). Hospital and follow-up outcome was compared by propensity score adjusted multiregression analysis. BH included 116 on-pump and 124 off-pump (OPCAB) procedures. There was a propensity to operate CS patients on the beating heart (multivariate odds ratio [OR], 3.8; P=0.001). Under stable hemodynamics significant predictors for BH selection were logEuroSCORE >20% (OR, 2.05), creatinine >1.8 mg/dL (OR, 4.12), complicated percutaneous coronary intervention (OR, 1.88), ejection fraction