Coronary artery bypass grafting for acute coronary syndrome

概要

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Since the drug eluting stents have appeared in Japan, the indication of percutaneous coronary intervention has wide-spread for the treatment of coronary artery disease. In this decade, 216 patients underwent emergency/urgent coronary artery bypass grafting (CABG) in our institute, while the annual numbers of both emergency and elective CABG cases have declined. On the contrary to the decreasing number, emergency CABG patients were significantly getting older with multiple co-morbidities. Thus, off-pump CABG was likely to be beneficial for preventing postoperative complications, leading to the reduction of postoperative mortality. When emergency CABG patients developed refractory myocardial ischemia and unstable hemodynamics, a percutaneous cardiopulmonary support system was quickly applicable and useful for on-pump beating CABG achieving complete surgical revascularization. In the present study, 1.8% of hospital mortality and 72.5% of a 10-years actuarial survival were documented. Although a trend of ACS patients were getting older and had multiple comorbidities in this decade, early and long-term outcomes following emergency CABG were considered to be acceptable.