[Emergent coronary artery bypass grafting in patients with acute coronary syndrome].

The incidence of emergent CABG in patients with acute coronary syndrome has been decreasing, because thrombolytic therapy and/or catheter intervention have proved to be done faster and more efficient. The present indication of CABG is mostly limited to patients with left main trunk lesion or severe triple vessel disease, whose PTCA is failed with persistent chest pain or unstable hemodynamic condition. The factors associated with an increased hospital mortality are ejection fraction < 30%, age > 70 years, presence of cardiogenic shock, and cardiac index < 1.5. The interval between operation and AMI is not a significant risk factor. The prognosis of the operative survivors is relatively good. The use of the internal thoracic artery graft does not influence on the early outcome as far as the preoperative hemodynamic condition is stable. To get better surgical results, improvements in intraoperative myocardial protection and in postoperative cardiac support are imperative.