Comparison of Hospital Outcomes of Patients Who Undergo Urgent CABG Compared to Patients Who Undergo Elective CABG
Amir Ghaffari Jolfayi, Nima Taheri, Zahra Hosseini, Arezoo Rezaei, Atefeh Kashanizadeh, Zahra Amir Sardari, Erfan Kohansal, Amir Askarinejad, Ali Mohammad Nasirian, Mansoor Namazi, Ata FirouziBackground
Coronary artery bypass grafting (CABG) is one of the most common cardiac surgeries worldwide. Whether performed electively or urgently, CABG is associated with significant differences in postoperative outcomes. Urgent CABG is associated with higher postoperative morbidity and mortality, often influenced by preoperative cardiac risk factors. This study compares the demographics, clinical characteristics, and outcomes of patients undergoing urgent versus elective CABG.
Methods
This retrospective study analyzed data from 4872 patients who underwent CABG between 2019 and 2022 at Rajaie Cardiovascular Medical and Research Institute. Urgent CABG was defined as surgery performed within 24–72 h (mostly within 48 h) of a precipitating clinical event. The primary outcome was in‐hospital mortality, while secondary outcomes included postoperative complications such as cardiac arrest and acute kidney injury. Echocardiographic indices and laboratory parameters were also evaluated. Multivariable logistic regression analysis was performed to identify independent risk factors associated with in‐hospital mortality.
Results
In this study of 4872 patients undergoing CABG, 81.6% had elective and 18.4% had urgent surgery. Urgent CABG was associated with significantly higher in‐hospital mortality compared with elective procedures (6.8% vs. 2.7%, p = 0.01), while the rate of acute kidney injury was similar. In multivariable logistic regression analysis, increasing age, longer cardiopulmonary bypass time, renal dysfunction, and urgent surgery independently increased the risk of in‐hospital mortality, while higher preoperative LVEF was protective.
Conclusion
Primary outcome and mortality after CABG are determined by a combination of patient‐ and procedure‐related factors. Older age, renal dysfunction, prolonged cardiopulmonary bypass time, lower preoperative ejection fraction, and urgent surgical status significantly increase the risk of early postoperative death, with urgent CABG more than doubling mortality compared with elective surgery. These findings emphasize the importance of individualized risk assessment, timely referral, optimal preoperative stabilization, and meticulous perioperative management, particularly in high‐risk and urgent cases, to improve short‐term surgical outcomes and reduce in‐hospital mortality.