Early outcomes of emergency coronary artery bypass grafting based on institutional technique selection: a single-center retrospective cohort study.

BACKGROUND

Emergency coronary artery bypass grafting (CABG) in high-risk patients remains a major perioperative challenge, and surgical strategy is often determined by clinical and anatomical factors rather than randomization. This study aimed to describe early outcomes of emergency CABG within a structured institutional technique selection framework.

METHODS

This retrospective cohort study included 59 consecutive patients who underwent emergency isolated CABG between 2004 and 2007. Patients were allocated to on-pump (n = 39) or off-pump (n = 20) CABG according to a predefined institutional algorithm incorporating hemodynamic status, coronary anatomy, and comorbidities. Outcomes are presented descriptively, and between-group comparisons are interpreted in the context of inherent selection bias.

RESULTS

Substantial baseline and procedural differences were observed between groups, reflecting structured technique selection rather than random allocation. Patients undergoing on-pump CABG had more complex coronary anatomy and higher clinical acuity, including all four cardiogenic shock cases and 92.6% of triple-vessel grafting procedures. Longer operative time, increased inotropic support, and longer hospital stay were observed in the on-pump group; CK-MB levels at 1 h were lower in the off-pump group. In-hospital mortality was low and comparable (7.7% vs. 5.0%, p = 1.000). Given the marked selection bias and limited sample size, these findings should be considered descriptive rather than comparative.

CONCLUSION

In this historical cohort of emergency CABG patients, both on-pump and off-pump techniques were feasible within a structured institutional selection framework. Observed differences in early outcomes likely reflect underlying patient characteristics rather than intrinsic superiority of either technique. These findings highlight the importance of individualized, algorithm-guided decision-making in emergency surgical revascularization.