Abstract
Purpose: This review evaluates surgical revascularization strategies in patients with acute coronary syndrome (ACS), focusing on optimal timing, patient selection criteria, and a comparative analysis with percutaneous coronary interventions (PCI). The study aims to provide a comprehensive overview of the indications, benefits, and limitations of surgical approaches in the context of multi-vessel disease and other complex ACS presentations.
Methods: A literature review was conducted, drawing from clinical trials, observational studies, and current guidelines on ACS management. Key studies examining outcomes of coronary artery bypass grafting (CABG) in ACS, including on-pump and off-pump techniques, were analyzed alongside PCI trials to assess the effectiveness and safety of these approaches.
Key Findings: Surgical revascularization, particularly CABG, offers advantages in selected ACS populations, such as those with multi-vessel disease or failed PCI, and is critical for patients with structural complications like ventricular septal rupture. Off-pump CABG (OPCAB) shows potential benefits in reducing systemic inflammation and perioperative complications, though patient selection remains essential. Guidelines recommend CABG for high SYNTAX score patients and in cases of left main disease, with emerging evidence supporting staged revascularization in multi-vessel disease to reduce adverse events. Comparatively, PCI offers rapid revascularization but may require repeat interventions, particularly in patients with complex coronary anatomy or comorbidities.
Conclusion: Surgical revascularization remains a crucial component of ACS management, particularly for complex cases where PCI is unsuitable or incomplete. This review underscores the importance of individualized patient assessment, the need for further comparative trials, and the role of the heart team approach in optimizing outcomes for ACS patients. Future research should focus on refining patient selection criteria and exploring hybrid revascularization approaches to improve clinical practice.