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Objectives: Coronary artery bypass grafting (CABG) surgery in patients with acute coronary syndrome (ACS) remains a high-risk procedure and is associated with adverse outcomes. The risk factors of acute stroke in the above-mentioned patients stay unclear and some appropriate data is lacking in the literature. Thus, we aimed to investigate the predictors of acute stroke in patients undergoing CABG surgery in ACS., Methods: The retrospective single-centre cohort analysis was conducted. All patients ( n = 1344) who suffered from acute coronary syndrome and underwent CABG procedure at the University hospital Cologne from June 2011 until October 2019 were included in our study. In order to find the risk factors of acute stroke after bypass surgery, patients were divided into two groups (non-stroke group ( n = 1297) and stroke group ( n = 47)). In order to even above-mentioned groups propensity score matching (PSM) analysis was performed (non-stroke group ( n = 46) and stroke group ( n = 46)., Results: Duration of cardiopulmonary bypass ( p = .015) and cross clamp time ( p = .006) were significantly longer in patients who suffered stroke. Perioperative myocardial infarction was significantly higher ( p = .030) in the stroke group. Likewise, the duration of intensive care unit stay ( p < .001) and in-hospital stay ( p < .001) were significantly longer in patients with stroke. However, the mortality rate did not differ significantly ( p = .131) between above-mentioned groups. Univariate and multivariate analysis showed cardiogenic shock ( p = .003), peripheral vascular disease (PVD, p = .025) and previous stroke ( p = .045) as relevant independent predictors for acute stroke after CABG procedure in patients with ACS., Conclusion: Based on our findings, acute stroke after bypass surgery in patients with ACS is associated with increased mortality and adverse outcomes. Cardiogenic shock, peripheral vascular disease and previous stroke were independent predictors of stroke after CABG procedure. Therefore, preoperative evaluation of potential risk factors may be crucial to improve postoperative results.

Objective: Patients with acute coronary syndrome are treated with dual antiplatelet therapy containing acetylsalicylic acid (ASA) and P2Y12 antagonists. In case of urgent coronary artery bypass grafting this might be associated with increasing risks of bleeding complications., Methods: Data from 1200 consecutive urgent operations between 2010 and 2018 were obtained from our institutional patient database. For this study off-pump surgery was excluded. The primary composite end point major bleeding consisted of at least one end point: transfusion ≥ 5 packed red blood cells within 24 hours, rethoracotomy due to bleeding, chest tube output >2000 mL within 24 hours. Demographic data, peri-, and postoperative variables and outcomes were compared between patients treated with mono antiplatelet therapy, ASA + clopidogrel (ASA-C) +ticagrelor (ASA-T) or +prasugrel (ASA-P) < 72 hours before surgery. Furthermore, we compared patients with dual antiplatelet therapy with ASA monotherapy., Results: From 1,086 patients, 475 (44%) received dual antiplatelet therapy. Three-hundred seventy-two received ASA-C (77.7%), 72 ASA-T (15%), and 31 ASA-P (6.5%). Major bleeding (44 vs. 23%, p  < 0.0001) was more frequently in patients receiving dual therapy with higher rates of massive drainage loss within 24 hours (23 vs. 11%, p  < 0.0001) of mass transfusion (34 vs. 16%, p  < 0.0001) and rethoracotomy (10 vs. 5%, p  = 0.002) when compared with ASA. In this analysis, ASA-T and ASA-P were not associated with higher bleeding complications compared with ASA-C., Conclusion: Dual antiplatelet therapy is associated with higher rates of major bleeding. Further studies should examine the difference in the prevalence of major bleeding complications in the different dual antiplatelet therapy regimes in patients requiring urgent surgery., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: Choice of cardioplegic solution plays a pivotal role in special subgroups of patients referred for on-pump cardiac surgery. This retrospective analysis aimed to assess the impact of intermittent warm (Calafiore, Cala) versus intermittent cold blood cardioplegia (Buckberg, Buck) in patients referred to coronary artery bypass graft (CABG) surgery due to acute coronary syndromes (ACS)., Methods: From 2008 to 2015, all consecutive patients undergoing urgent on-pump CABG surgery due to ACS ( n  = 950) were retrospectively analyzed. Intraoperative cardiac arrest was achieved using Buck ( n  = 273) or Cala ( n  = 677). Patients were compared regarding clinical outcomes and perioperative myocardial injury (PMI). Propensity score matching was performed to control for differences in preoperative patient characteristics., Results: Prevalences of left main stenosis >50%, COPD, and advanced New York Heart Association (NYHA) class were higher for intermittent warm blood cardioplegia (IWC)-patients while more Buck-patients had preoperative intra-aortic balloon pump (IABP) and redo procedures. Buck-patients needed more intraoperative defibrillations and showed longer cardiopulmonary bypass (CPB) and aortic clamping times. 30-day all-cause mortality (10.6 versus 9.3%), major adverse cardiac events (MACE) (52.7 versus 48.6%), and PMI (50.5 versus 55.7%; all p  > 0.05) rates were comparable for Buck- and Cala-patients. Propensity score matching resulted in equal group sizes ( n  = 212 each) and balanced distribution of preoperative covariates. Although more Buck-patients still needed inotropic support >24 hours postoperatively (25.7 versus 14.7%; p  = 0.005) compared with Cala-group, outcome variables of interest did not differ between treatment groups (30-day mortality: 7.5 versus 9.0%; MACE: 49.5 versus 40.6%; PMI: 48.1 versus 37.3%; all p  > 0.05)., Conclusion: Buckberg and Calafiore cardioplegia offer comparable myocardial protection and similar postoperative results in patients undergoing CABG surgery due to ACS., Competing Interests: None., (Georg Thieme Verlag KG Stuttgart · New York.)

Background Urgent or emergency coronary artery bypass grafting in patients with acute coronary syndrome is associated with increased morbidity and mortality. We investigated the effects of preoperative intraaortic balloon pump support in this high-risk patient cohort. Methods Our institutional database was retrospectively reviewed for patients with acute coronary syndrome and an urgent or emergency indication for coronary artery bypass from April 2010 to December 2016. Data of 1066 patients were analyzed. We assessed the impact of preoperative intraaortic balloon pump therapy on postoperative mortality and major adverse cardiovascular and cerebrovascular events, and performed propensity-score matching. Results Intraaortic balloon pump support was implemented in 223 (20.9%) patients: 55 (5.2%) preoperatively and 168 (15.8%) intra- or postoperatively. Overall hospital mortality was 8.8%. Patients with a preoperative intraaortic balloon pump had increased mortality (11/55, 20%) compared to controls ( p = 0.006). After propensity-score matching, all-cause mortality (20.0% vs. 18.2%, p = 0.834), cardiac mortality (18.2% vs. 14.5%, p = 0.651), and major adverse cardiovascular and cerebrovascular events (29.1% vs. 27.3%, p = 0.855) were comparable between groups. Conclusions Preoperative intraaortic balloon pump support does not confer any additional clinical benefit on patients undergoing coronary artery bypass grafting for acute coronary syndrome.