Early Surgical Myocardial Revascularization in Non-ST-Segment Elevation Acute Coronary Syndrome

Objectives: In non-ST-elevation myocardial infarction (NSTEMI) there is no consensus regarding optimal time point for coronary artery bypass grafting (CABG). Recent findings suggest that long-term outcomes are improved in early-revascularized NSTEMI patients. However, it has been stated that early surgery is associated to increased operative risk. In this study, we wanted to elucidate if early coronary artery bypass grafting in non-ST-elevation acute coronary syndrome can be performed safely.

Methods: We performed a prospective observational study within a 2-year interval (2013–2015). 217 consecutive patients (41 female, age 68,9 ± 10,2, ES II 6,62 ± 8,56) had non-ST-elevation myocardial infarction (NSTEMI) and were enrolled for surgical revascularization in our institution. Patients were divided into two groups according to the time point of coronary artery bypass after symptom onset (Group A: < 72 hour; Group B: >72 hour). Endpoints included 6-month mortality and incidence of MACE (death, stroke or re-infarction) in the 6-month follow-up.

Results: There were no differences regarding mortality between both groups (30 days: Group A 2.4 vs. Group B 3.7%; p = 0.59; 6 months: 8.4 vs. 6.0%; p = 0.48). Incidence of MACE in the 6-month follow-up were also similar in both groups (Group A: 10.3 vs. 10.2%, p = 0.982). Regression analysis revealed as independent risk factors for mortality in the entire cohort ES II OR 1.045 (95% CI: 1.004–1.088). ES II remained an independent prognostic factor in group A OR 1.043 (95% CI: 1.003–1.086) and group B OR 1.032 (95% CI: 1.001–1.063).

Conclusion: Early revascularized patients showed a higher level of illness. However, results of early CABG were comparable to those following delayed revascularization. Moreover, EuroScore II was determined as independent risk factors for mortality.