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Joo et al. Vessel Plus 2018;2:2 Vessel Plus
DOI: 10.20517/2574-1209.2017.36

Review Open Access

Surgical revascularization for acute coronary
syndromes: a narrative review

Joseph H. Joo , Joshua M. Liao , Faisal G. Bakaeen , Danny Chu 4
2
1
3
1 College of Medicine, Texas A&M University, Bryan, TX 77807, USA.
2 Department of Medicine, University of Washington, Seattle, WA 98195, USA.
3 Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, OH 44195, USA.
4 Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
Correspondence to: Prof. Danny Chu, Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh
School of Medicine, 200 Lothrop Street, C-700 Pittsburgh, PA 15213, USA. E-mail: chud@upmc.edu

How to cite this article: Joo JH, Liao JM, Bakaeen FG, Chu D. Surgical revascularization for acute coronary syndromes: a narrative
review. Vessel Plus 2018;2:2. http://dx.doi.org/10.20517/2574-1209.2017.36
Received: 30 Nov 2017 First Decision: 15 Jan 2018 Revised: 23 Jan 2018 Accepted: 24 Jan 2018 Published: 2 Feb 2018

Science Editor: Mario F. L. Gaudino Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
Acute coronary syndrome (ACS) comprises a spectrum of disease that includes unstable angina, non-ST-elevation
myocardial infarction, and ST-elevation myocardial infarction. Clinical management of patients with ACS has greatly
evolved over the last two decades, but ACS remains an important cause of morbidity and mortality in patients with
coronary artery disease. This narrative review describes the indication, timing, and approaches to surgical revascularization
in the context of ACS. In particular, the review discusses and compares the utilization of off-pump coronary artery bypass
grafting (CABG) vs. conventional on-pump CABG. Other surgical interventions, such as totally endoscopic coronary artery
bypass and hybrid coronary revascularization, are also reviewed.

Keywords: Acute coronary syndromes, coronary artery bypass graft, off pump coronary artery bypass

INTRODUCTION
Acute coronary syndrome (ACS) comprises a spectrum of disease that includes unstable angina (UA),
non-ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI), with
distinctions based on symptom severity, electrocardiogram patterns, and degree of myocardial necrosis as
reflected by cardiac biomarker levels . In-hospital and long-term mortality have improved largely because
[1-3]
of improvements in ACS treatment modalities . However, ACS remains an important cause of morbidity
[4-8]
and mortality in patients with coronary artery disease that is responsible for more than 1 million hospital
admissions in the USA annually . Concurrently, indications for surgical revascularization in ACS patients
[9]
© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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