RESUMEN
Emergency coronary artery bypass grafting (CABG) in patients with acute coronary syndrome (ACS) is still associated with high mortality and morbidity, and early outcome is poor compared with outcome in patients with stable angina. The purpose of this study was to examine the clinical results of on-pump beating heart CABG vs. off-pump coronary artery bypass (OPCAB) for ACS patients. From a total of 432 CABG patients, we retrospectively analyzed 72 (16.7%) patients who underwent emergency CABG between 2004 and 2008. Emergency CABG cases were divided into 2 operative groups : an on-pump beating-heart CABG group (on, <i>n</i>=31) and an OPCAB group (off, <i>n</i>=41). A preoperative history of acute myocardial infarction (AMI), detection of troponin T, preoperative creatine phosphokinase (CPK) value, low ejection fraction, presence of mitral regurgitation (MR) (>II) and cardiomegaly were markedly higher in the on group. There were no statistically significant differences in intraoperative factors. In-hospital mortality was 3.2% (1 patient) in the on group and 7.3% (3 patients) in the off group. Furthermore, statistically significant differences were found between the 2 groups in incidence of all-cause morbidity (on=71.0% : off=41.5%, <i>p</i>=0.01), respiratory failure (on=58.1% : off=29.3%, <i>p</i>=0.01), ICU stay (on=6.5±4.6 days : off=4.1±3.2 days, <i>p</i>=0.01), and necessary inotropic support (on=51.6% : off=17.1%, <i>p</i>=0.02). Multivariate regression analysis of preoperative and intraoperative factors was performed to identify independent factors for in-hospital mortality and morbidity. On multivariate analysis of preoperative factors, only the pre-CPK value reached statistical significance as an independent factor for in-hospital mortality and morbidity.
RESUMEN
We report a 77-year-old man treated successfully surgical coronary revascularization following out-of-hospital cardiac arrest. The patient suddenly suffered from loss of consciousness with cardiopulmonary arrest on June 3, 2007. His wife quickly started cardiac massage and a bystander called an ambulance. Using an automated external defibrillator, paramedics performed defibrillation, which started his heart beating again in 30 min. He was then transferred by ambulance to the emergency room in our hospital. Severe coronary artery disease (left main disease and three-vessel disease) was diagnosed on June 11 after treatment for congestive heart failure and confirmation of good consciousness. Thereafter, urgent on-pump beating coronary artery bypass grafting was performed. On the 45th post operative day, the patient was discharged to home with an acceptable level of daily life activity. To the best of our knowledge, this is the fifth such case report in the Japanese literature.