Open AccessCoronary artery bypass grafting in the treatment of patients with acute coronary syndrome: current evidence base and unresolved issues
Author(s) -
Т. С. Головина,
Ю. Н. Неверова,
Р. С. Тарасов
Publication year - 2021
Publication title -
rossijskij kardiologičeskij žurnal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.141
H-Index - 14
eISSN - 2618-7620
pISSN - 1560-4071
DOI - 10.15829/1560-4071-2021-4259
Subject(s) - medicine , acute coronary syndrome , cardiology , conventional pci , perioperative , percutaneous coronary intervention , artery , bypass grafting , myocardial infarction , revascularization , surgery
The issue of the optimal timing of coronary artery bypass grafting (CABG) in acute coronary syndrome (ACS) remains controversial. It is known that on the one hand there will be a delay in revascularization, leading to recurrent myocardial infarction with irreversible cardiac dysfunction. On the other hand, there is an increased incidence of perioperative complications associated with surgery. This article provides a detailed analysis of the evidence base and current guidelines on the validity and timing of coronary artery bypass grafting in various types of ACS. The emphasis is made on the contradictions regarding the earlier implementation of the active strategy in non-ST segment elevation ACS. We describe problem of insufficient evidence base on optimal timing of CABG, comparison of outcomes of percutaneous coronary intervention (PCI) performed in the first 24 hours and open surgery for high-risk non-ST segment elevation ACS, as well as a number of organizational and clinical issues to ensure the surgery availability.