[Myocardial revascularization of acute coronary syndromes in Clinic of Cardiac Surgery at Kaunas University of Medicine Hospital (experience of 5 years)].

UNLABELLED: A retrospective study of patients undergoing emergent and urgent coronary artery bypass grafting for acute coronary insufficiency was performed to identify the risk factors for hospital death specifically associated with the clinical severity of the acute coronary insufficiency syndrome.

MATERIAL AND METHODS: The 104 patients were divided into three groups - emergent, urgent A, urgent B - on the basis of the evaluation of the clinical pattern of the acute coronary insufficiency syndrome on full medical treatment. The three groups were defined as follows: emergent (26 patients), prompt myocardial revascularization was required because medical treatment achieved only transient regression of myocardial ischemia; urgent A (29 patients), myocardial revascularization could be delayed for 24 to 72 hours after beginning of chest pain because of adequate control of ischemia; urgent B (49 patients), these patients had operation after 72 hours after beginning of chest pain because mild episodes of recurrent ischemia not required urgent revascularization.

RESULTS: Hospital mortality 14 patients. Mortality rates were 30.8% for the emergent group, 13.8% for the urgent A group, and 4.1% for the urgent B group. Death resulted from cardiac-related causes in 10 patients. Surgery performed at a later stage has good results if performed in a non emergency situation, specially after the first 72 hours.

CONCLUSIONS: Including patients undergoing semielective revascularization procedures would lead to better results, thus giving the impression of low mortality rates in a acute coronary syndromes category of patients. Employment of a more exact definition of patients risk and the identification of new risk factors make the interpretation of the outcome data clearer.