Background
Limited information exists on whether changes in medical practices over the study
decades have affected the outcomes of acute coronary syndrome (ACS) patients who undergo
early coronary artery bypass surgery (CABG) during index hospitalisation.
Methods
Data on trends for early CABG referral and associated outcomes were obtained among
11,485 ACS patients enrolled in the biennial Acute Coronary Syndrome Israeli Surveys
(ACSIS) 2000–2010.
Results
Among 11,485 patients, 566 (5%) were referred to early CABG. These patients displayed
higher risk characteristics, including Killip class >II, anterior myocardial infarction,
greater left ventricular dysfunction, and more frequent use of mechanical ventilation
and intra-aortic balloon pump (all p < 0.01). Nevertheless, mortality rates of patients referred to early CABG vs. treated
with percutaneous coronary intervention (PCI) or medically, was similar (11.4% vs.
10.2%; log-rank p-value = 0.40).
There was a significant decline in the referral trend over the study decade (6.7%
– 1.7%; p < 0.001). One year survival was similar between patients referred to early CABG during
the late (years: 2006–2010) vs. early (years: 2000–2005) period (85.7% vs. 90%; log-rank
p-value = 0.15), whereas, among patients who didn’t undergo early CABG, and underwent percutaneous
coronary intervention (PCI) or medical management only, enrolment during the late
periods was associated with a significant survival benefit (91.5% vs. 88.1%; log-rank
p-value<0.001).
Conclusions
Over the study decade there was a significant decline in referral for early CABG,
without a difference in the one-year mortality between the early and non-early CABG
group.
Keywords
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Article info
Publication history
Published online: March 01, 2017
Accepted:
January 19,
2017
Received in revised form:
January 11,
2017
Received:
June 24,
2016
Identification
Copyright
© 2017 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
