Emergency Coronary Artery Bypass Graft Surgery for Acute Coronary Syndrome Beating Heart Versus Conventional Cardioplegic Cardiac Arrest Strategies

Background—Aim of this study was to compare the outcome of beating heart versus conventional coronary artery bypass graft (CABG) strategies in acute coronary syndromes for emergency indications. Methods and Results—638 consecutive patients with acute coronary syndrome (ACS) receiving emergency CABG surgery via midline sternotomy from January 2000 to September 2005 were evaluated. Propensity score analysis was used to predict the probability of undergoing beating heart (BH) (n240) versus cardioplegic cardiac arrest (CA) (n398) strategies. Patients presented with stable hemodynamics (n531) or in cardiogenic shock (CS) (n107). Hospital and follow-up outcome was compared by propensity score adjusted multiregression analysis. BH included 116 on-pump and 124 off-pump (OPCAB) procedures. There was a propensity to operate CS patients on the beating heart (multivariate odds ratio [OR], 3.8; P0.001). Under stable hemodynamics significant predictors for BH selection were logEuroSCORE 20 % (OR, 2.05), creatinine 1.8 mg/dL (OR, 4.12), complicated percutaneous coronary interventio