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Page 4 of 8 Joo et al. Vessel Plus 2018;2:2 I http://dx.doi.org/10.20517/2574-1209.2017.36

TIMING OF SURGICAL REVASCULARIZATION
In most patients with ACS who are to undergo CABG surgery, the procedure is postponed for several days to
[8]
reduce procedure-related risk . The exceptions are patients with life-threatening conditions, such as severe
disease or mechanical complications, who undergo early CABG. In another, AMI patients with persistent
nonmechanial complications (persistent ischemia, shock), mortality rates when surgical revascularization
was performed within 48 h of AMI were 7.7% for on-pump procedures performed because of persistent
[67]
pain, but were negligible in those done more than 48 h later . Other work looking at patients undergoing
CABG after AMI has produced similar numbers and has associated early operation with higher risk in both
transmural and non-transmural AMI . There has been some suggestions, however, that even in higher-risk
[68]
patients, early CABG is associated with very low in-hospital mortality and, therefore, could be considered
in appropriate situations . For OPCABG, data suggest that patients taken to the operating room within 6 h
[8]
from the onset of chest pain are more suitable for off-pump surgery and have a low incidence of conversion
[54]
to on-pump CABG, which, as mentioned above, carries severe risks and consequences .

CONCLUSION
Though the management of ACS has greatly evolved over the last two decades, the condition remains an
important cause of morbidity and mortality in patients with coronary artery disease. Surgical revascularization
is favored for more complex and high-risk patients. The merits of OPCABG remain debatable, and further
study is needed to quantify the benefits of TECAB and HCR as emerging procedures for ACS.

DECLARATIONS
Acknowledgments
The authors would like to thank Stephen N. Palmer, PhD, ELS, for his contributions to the editing of earlier
versions of the manuscript, for which he was not financially compensated.

Author’s contributions
Concept/design: all authors
Definition of intellectual content: all authors
Literature search: all authors
Manuscript preparation, editing, and review: all authors

Financial support and sponsorship
None.

Conflicts of interest
Dr. Chu serves as an oral board review examiner for The Osler Institute, academic editor for Wolters Kluwer
Health, and national proctor for Toray International America, Inc., and the Japanese Organization for Medical
Device Development, Inc., none of which have relationship to this manuscript. Dr. Liao, Dr. Bakaeen, and Mr.
Joo have no conflicts to disclose.

Patient consent
Not applicable.

Ethics approval
Not applicable.

Copyright
© The Author(s) 2018.