Coronary Artery Bypass Grafting During Acute Coronary Syndrome: Outcomes and Comparison of Off-Pump to Conventional Coronary Artery Bypass Grafting at a Veteran Affairs Hospital.

MedStar author(s):
Citation: Innovations: Technology & Techniques in Cardiothoracic & Vascular Surgery. 10(3):157-62, 2015 May-Jun.PMID: 26177477Institution: MedStar Washington Hospital CenterDepartment: Surgery/General SurgeryIN - Emerson,Dominic A. From the *Veterans Affairs Medical Center; +Georgetown University Hospital; and ++The George Washington University Hospital, Washington, DC USA.Form of publication: Journal ArticleMedline article type(s): Comparative Study | Journal ArticleSubject headings: *Acute Coronary Syndrome/su [Surgery] | *Coronary Artery Bypass, Off-Pump/mt [Methods] | *Coronary Artery Bypass/mt [Methods] | Acute Coronary Syndrome/pp [Physiopathology] | Aged | Comorbidity | Coronary Artery Bypass, Off-Pump/ae [Adverse Effects] | Coronary Artery Bypass/ae [Adverse Effects] | Female | Follow-Up Studies | Humans | Kaplan-Meier Estimate | Length of Stay | Male | Middle Aged | Proportional Hazards Models | Retrospective Studies | Risk Factors | Survival Rate | Treatment Outcome | United States | United States Department of Veterans AffairsYear: 2015Local holdings: Available online through MWHC library: Fall 2005 - presentISSN:
  • 1556-9845
Name of journal: Innovations (Philadelphia, Pa.)Abstract: CONCLUSIONS: ACS appears to negatively impact long-term, but not short-term, mortality. Within the ACS group, OPCABG compares favorably to cCABG in the long-term and also improves short-term morbidity.METHODS: A retrospective review of prospectively collected data was undertaken. Patients undergoing isolated CABG from January 2000 to December 2011 with ACS were identified (n = 271); non-ACS patients (n = 854) were established as a control. Data were analyzed with a chi or a t test, where appropriate. Survival was compared using Kaplan-Meier analysis and Cox proportional hazards model.OBJECTIVE: The management of acute coronary syndrome (ACS) has evolved dramatically over the last 50 years. Currently, management includes a multidisciplinary approach potentially including catheter-based therapy, surgery, or purely medical management. Where surgical therapy is indicated, data regarding long-term outcomes are limited. In particular, little data exist regarding on-pump (conventional coronary artery bypass grafting, cCABG) versus off-pump (OPCABG) outcomes for this group.RESULTS: Thirty-day mortality between the ACS and the control groups was similar; however, long-term mortality was worse for the ACS group (P = 0.032; median follow-up, 5.5 years). Length of stay and composite morbidity were higher in the ACS group (P < 0.01). Subgroup analysis of ACS patients (OPCABG vs cCABG) demonstrated worse preoperative comorbidities in the OPCABG group, but similar 30-day and long-term mortality. However, the cCABG group had higher rates of reoperation (P = 0.034) and longer length of stay (P = 0.017) and operative time (P < 0.0001). Cox proportional hazards model was applied. Risk factors for the non-ACS cohort included age, diabetes, OPCABG, and ACS (P < 0.05). Among the ACS cohort, only age remained a statistically significant factor (P < 0.0001).Fiscal year: FY2015Digital Object Identifier: Date added to catalog: 2016-06-03
Holdings
Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 26177477 Available 26177477

Available online through MWHC library: Fall 2005 - present

CONCLUSIONS: ACS appears to negatively impact long-term, but not short-term, mortality. Within the ACS group, OPCABG compares favorably to cCABG in the long-term and also improves short-term morbidity.

METHODS: A retrospective review of prospectively collected data was undertaken. Patients undergoing isolated CABG from January 2000 to December 2011 with ACS were identified (n = 271); non-ACS patients (n = 854) were established as a control. Data were analyzed with a chi or a t test, where appropriate. Survival was compared using Kaplan-Meier analysis and Cox proportional hazards model.

OBJECTIVE: The management of acute coronary syndrome (ACS) has evolved dramatically over the last 50 years. Currently, management includes a multidisciplinary approach potentially including catheter-based therapy, surgery, or purely medical management. Where surgical therapy is indicated, data regarding long-term outcomes are limited. In particular, little data exist regarding on-pump (conventional coronary artery bypass grafting, cCABG) versus off-pump (OPCABG) outcomes for this group.

RESULTS: Thirty-day mortality between the ACS and the control groups was similar; however, long-term mortality was worse for the ACS group (P = 0.032; median follow-up, 5.5 years). Length of stay and composite morbidity were higher in the ACS group (P < 0.01). Subgroup analysis of ACS patients (OPCABG vs cCABG) demonstrated worse preoperative comorbidities in the OPCABG group, but similar 30-day and long-term mortality. However, the cCABG group had higher rates of reoperation (P = 0.034) and longer length of stay (P = 0.017) and operative time (P < 0.0001). Cox proportional hazards model was applied. Risk factors for the non-ACS cohort included age, diabetes, OPCABG, and ACS (P < 0.05). Among the ACS cohort, only age remained a statistically significant factor (P < 0.0001).

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