Early clinical outcomes in emergency CABG in the United Kingdom.

Introduction: There is a paucity of evidence in the literature on trends, revascularisation techniques, and early clinical outcomes for patients undergoing emergency coronary artery bypass grafting (CABG). Method: All patients who underwent first-time, emergency isolated CABG in the United Kingdom from 1996 to April 2019 were identified from the National Adult Cardiac Surgery Audit database. Trend, early clinical outcomes, and revascularisation technique (on-pump and off-pump) were analysed. Results: A total of 8,221 patients were included; the median age was 67.9 years and 71% were male. The number of emergency CABG procedures fluctuated over the study period, ranging from approximately 350 cases per year in the early 2000s to around 525 in 2004. Since then, the number has declined, reaching approximately 325 procedures per year. Off-pump coronary bypass (OPCAB) was used in 12% of cases. The overall mortality was 10.9%, and the incidence of return to theatre was 9.4%. Transient ischaemic attack (TIA) occurred in 1.0% of patients, while stroke was observed in 1.7%. The incidence of postoperative dialysis was 8.5%, and deep sternal wound infection occurred in 1.0% of patients. After inverse probability treatment weighting (generating two balanced groups), OPCAB when compared with ONCAB was associated with a lower in-hospital mortality (8.7% vs. 11.2%, Conclusion: Emergency CABG remains a high-risk operation with significant in-hospital mortality. The use of OPCAB seems to be associated with lower in-hospital mortality and incidence of return to theatre.