Acute coronary syndrome early after surgical myocardial revascularization: a single-center study and propensity score matching analysis

Rationale. Acute coronary syndrome (ACS) is a life-threatening complication that can occur in the perioperative period of coronary artery bypass grafting (CABG). Objective: to analyze the causes, recognition capabilities, risk factors, immediate treatment results and hospitalization outcomes in patients with perioperative ACS that developed after CABG. Methods. The main study group included 45 patients with ACS (group I) who underwent percutaneous coronary intervention (PCI) at the Pirogov Center in 2016–2025 after CABG and emergency coronary bypass angiography (CAG). Using the propensite score matching (PSM) from the control sample (sample size – 1000 patients after CABG without ACS), 45 patients after CABG without ACS (group II) were included in the control group. The average follow-up period for patients in both groups was 10 [7; 13] days. The primary endpoint of the study was death. Secondary endpoints were endovascular revascularization, resternotomy, bleeding, acute cerebrovascular accident (ACVA), and myocardial infarction (MI). Results. The death rate was 8 (17.8%, group I) versus 1 (2.2%, group II), OR 0.105, 95% CI 0.013–0.880, p = 0.030, resternotomy – 7 (15.6%, group I) versus 2 (4.4%, group II), OR 0.252, 95% CI 0.049–1.290, p = 0.157. Endovascular revascularization was performed in 38 (84.4%) patients of the main group, 12 (26.7%) patients of group I had a verified diagnosis of MI. Risk factors for the development of ACS after CABG: lack of arterial revascularization (OR 4.528; 95% CI 1.373–14.933, p = 0.013), incomplete revascularization (OR 4.385; 95% CI 1.254–15.332, p = 0.021). Conclusion. Perioperative ACS in the early period of CABG is a formidable complication and determines a statistically significantly higher frequency of fatal outcomes compared to patients without this complication. Isolated autovenous revascularization and incomplete myocardial revascularization are predictors of ACS, increasing the likelihood of its development by 4 times.