Regional experience of acute coronary syndrome surgical treatment

Abstract

Aim. To summarize the experience of surgical myocardial revascularization in acute coronary syndrome.

Methods. The study included 72 patients with acute coronary syndrome who underwent coronary artery bypass grafting in the department of cardiac surgery. All patients were allocated to 3 groups depending on the urgency and the risk of intervention: first group - emergency coronary artery bypass grafting; second group - urgent coronary artery bypass grafting in patients at high risk of adverse events; third group - delayed coronary artery bypass grafting in patients at low risk of adverse events.

Results. On-pump coronary artery bypass grafting was performed in 2 (25%) patients, off-pump coronary artery bypass grafting - in 6 (75%) patients, including 3 patients who were operated using parallel off-pump coronary artery bypass grafting technique. Positive clinical results were achieved in all patients. Patients with high risk for adverse events (n=55) underwent surgery in a period of 1 to 10 days from onset of disease (average delay was 4.3±2.6 days). Surgeries using extracorporeal circulation were performed in 39 (71%), including off-pump coronary artery bypass grafting - in 16 (29%), of whom 9 patients underwent parallel off-pump coronary artery bypass grafting. Intra-aortic balloon pump was used in 4 patients. Unfavorable outcome in this group was registered in 10 (13.8%) cases. Patients with a low risk of adverse events (n=9) underwent coronary artery bypass grafting after 10 days from the onset of the disease. All patients were operated using extracorporeal circulation. Unfavorable outcomes were not registered in that group.

Conclusions. A decision to perform coronary artery bypass grafting in patients with acute coronary syndrome with ST elevation is made when it is impossible to perform coronary angioplasty due to the isolated and combined stenosis of left main coronary artery and other arteries of the heart. Coronary artery bypass grafting in patients with acute coronary syndrome associated with a high risk for adverse events should be performed as an emergency intervention using intra-aortic balloon pump. Off-pump coronary artery bypass grafting is associated with a lower risk of adverse events, require little or no blood transfusion, and reduce hospital stay.

Keywords

unstable angina / acute coronary syndrome / coronary artery bypass grafting

References

[1] Агапов А.А., Тарасова Л.В., Ширяев А.А., Акчурин Р.С. Факторы риска коронарного шунтирования при нестабильной стенокардии // Кардиология. - 1996. - Т. 36, №11. - С. 49-53.

[2] Грицианский Н.А. Нестабильная стенокардия - острый коронарный синдром. Некоторые новые факты о патогенезе и их значение для лечения // Кардиология. - 1996. - Т. 36, №11. - С. 4-16.

[3] Мазур Н.А. Острый коронарный синдром // Терап. архив. - 1999. - Т. 71, №12. - С. 5-8.

[4] Antman E.M., Anbe D.T., Armstrong P.W. et al. American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction - executive summary: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction) // Circulation. - 2004. - Vol. 110. - Р. 588-636.

[5] Davies C.H. Revascularization for cardiogenic shock // Q. J. Med. - 2001. - Vol. 94. - P. 57-67. http://dx.doi.org/10.1093/qjmed/94.2.57

[6] Hochman J.S., Sleeper L.A., Webb J.G. et al. The SHOCK Investigators. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock // N. Engl. J. Med. - 1999. - Vol. 341, N 9. - Р. 625-634. http://dx.doi.org/10.1056/NEJM199908263410901

[7] Jeger R.V., Radovanovic D., Hunziker P.R. et al. The AMIS plus registry investigators. Ten-year trends in the incidence and treatment of cardiogenic shock // Ann. Intern. Med. - 2008. - Vol. 149, N 9. - Р. 618-626. http://dx.doi.org/10.7326/0003-4819-149-9-200811040-00005

[8] Sanborn T.A., Feldman T. Management strategies for cardiogenic shock // Curr. Opin. Cardiol. - 2004. - Vol. 19, N 6. - P. 608-612. http://dx.doi.org/10.1097/01.hco.0000142064.30214.1c

[9] Topalian S., Ginsberg F., Parrillo J.E. Cardiogenic shock // Crit. Care Med. - 2008. - Vol. 36, suppl. 1. - P. 66-74. http://dx.doi.org/10.1097/01.CCM.0000296268.57993.90

[10] Van de Werf F., Ardissino D., Betriu A. et al. Task force on the management of acute myocardial infarction of the European Society of Cardiology. Management of acute myocardial infarction in patients presenting with ST-segment elevation // Eur. Heart J. - 2003. - Vol. 24. - Р. 28-66. http://dx.doi.org/10.1016/S0195-668X(02)00618-8

[11] Van de Werf F., Bax J., Betriu A. et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology // Eur. Heart J. - 2008 - Vol. 29. - Р. 2909-2945. http://dx.doi.org/10.1093/eurheartj/ehn416

RIGHTS & PERMISSIONS

Yagafarov I.R., Sibagatullin N.G., Zakirov I.R., Tenin E.V., Ishmuratova Z.S., Faskhutdinov N.G., Sayfullin R.R., Bikchantaev A.A.